20091235 Ver 1_Application_20091117

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STATE OF NORTH CAROLINA
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DEPARTMENT OF TRANSPORTATION 41411y
BEVERLY EAVES PERDUE
GOVERNOR
November 10, 2009
Mr. Brian Wrenn
Division of Water Quality
401/Transportation Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
EUGENE A. CONPI, JR.
SECRETARY
X91235
SUBJECT: Pipe Replacement on Highway 27 East, Lincoln County
Dear Mr. Wrenn:
The North Carolina Department of Transportation requests authorization to replace three existing
pipes in conjunction with a widening project on Highway 27 from east of Hwy 150 to SR 1354
(Asbury Church Road) in Lincoln County. At Site 1 (St. 28+00), NCDOT proposes to replace the
existing 48-foot long 4'x 6' RCBC with an 120-foot long, 96" RCP on a different alignment. The
new pipe alignment will result in 50 feet loss of the old upstream channel; however, 25 feet of
upstream channel will be relocated to reconnect the stream to the new pipe. Therefore, the total
loss of the upstream channel will be 25 feet. The relocated channel will be reconstruced based
upon a reference cross-section surveyed -145 feet upstream of the existing pipe. The new pipe
alignment will also result in a loss of 70 feet of downstream channel. A 130 foot section of the
downstream channel will be relocated to an 85-foot step/pool channel to provide a better
culvert/stream alignment and also to reconnect the outlet invert to the downstream channel
elevation. The downstream relocation will result in 35 feet of stream loss. The outlet invert of
the new culvert will not be buried per regulation due to the construction of the step/pool channel
downstream of the outlet. The work at Site #1 will result in a total loss of 130 feet of stream
channel. At Site 2 (St. 30+80), NCDOT proposes to replace a 44-foot long, 4' x 6' RCP with
one 104-foot long, 66" RCP. The new pipe will result in a loss of 40 feet of downstream channel
(the upstream channel is non jurisdictional). Due to proposed slope of the new pipe (-5.2%),
the pipe will not be buried per regulation and will be placed at existing streambed grade. A 20-
foot armored scourhole will be constructed for energy dissipation. The work at Site #2 results
in a loss of 60 feet of stream channel. At Site 3 (St. 39+00), NCDOT proposes to replace a 39-
foot 3' x 4' RCP with a 36-foot long, 60" RCP. An 8-foot x 8-foot long dropbox will be
constructed at the outlet of the 36-foot long, 60" RCP and a 24-foot long, 66" RCP extended
from the dropbox and the invert placed on the existing streambed gradient (i.e. the pipe will not
be buried per regulation). The work at Site #3 results in a loss of 32 feet of stream channel.
temporary cofferdam system will be graded and restored back to pre-project conditions.
The scope of the work at the three permit sites will result in 222 feet of permanent impacts to
Hoyle Creek and two unnamed tributaries to Hoyle Creek, which is classified as a WS-V
watershed by the Division of Water Quality. Temporary cofferdam pumping systems will be
used to divert the stream flow around the construction sites, as needed. Area affected by
Post Office Box 47 Shelby, North Carolina 2 8 1 5 1-0047
Hwy 27 Widening
Page 2
November 10, 2009
This office has conducted a GIS and field survey for the project for historical sites and
threatened/endangered species sites. No sites listed on the National Register of Historic Places
are located in the vicinity of the project nor did there appear to be any eligible structures. The
federally listed species for Lincoln County (USFWS listed date January 3l, 2008) include
Michaux's sumac (Rhus michauxii) and the dwarf flowered heartleaf (Hexastylis nanii lora).
National Heritage Program records document the nearest Michaux's Sumac location
approximately 16.6 miles southeast (in Mecklenburg county) of the proposed project area. There
are no known sites of Michaux's sumac in Lincoln County. The sumac is typically found in
sandy or rocky, open woods and appears to survive best in areas with some disturbance, such as
artificially or naturally maintained clearings. There is no suitable habitat within the proposed
project area and no species were observed. National Heritage Program records document the
nearest dwarf-flowered heartleaf location approximately 3.5 miles southwest of the proposed
project area. The heartleaf is usually found on dry to moist ravine slopes (usually north facing
and of the oak-hickory-pine forest type) and in boggy areas near springheads. There is no
suitable habitat within the proposed project area and no species were observed. The proposed
project will have a finding of "no effect" on the dwarf flowered heartleaf (Hexastylis naniora)
or Michaux's sumac (Rhus michauxii).
Highway 27 is a rural arterial; however, the project area is not located within Yz mile of any
critical watershed area. Therefore, hazardous spill basins are not required. Enclosed is the
hazardous spill basin checklist.
I have enclosed a pre-construction notification for a NW#14 (WQC#3704), sketches of planned
activities and location maps relative to the project.
Project information for the 401 Automated Payment Procedure is as follows:
0 Work order number: 150470-55120005-37734.3.1-2170
• TIP#: W-4712
• Project Category: $240.00 Fee
If you have any questions or concerns please feel free to contact me at [phone]. Thank you for
your time and consideration on this matter.
Respectfully yours,
M.L. Holder, P.E.
Division Engineer
Twelfth Division
BY: J
Trish Simon
Division 12 Environmental Supervisor
Enclosures
cc Polly Lespinasse, Division of Water Quality, Mooresville Regional Office
O?O? W A7Fq,9
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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PCN Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ? Yes ® No
1d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
1e. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
? Yes ® No For the record only for Corps Permit:

® Yes ? No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes ® No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ? Yes ® No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ®No
2. Project Information
2a. Name of project: NC Highway 27 East
2b. County: Lincoln
2c. Nearest municipality / town: Boger City
2d. Subdivision name: NA
2e. NCDOT only, T.I.P. or state
project no: W-4712
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT Right of Way
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 12
PCN Form -Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is ? Agent ? Other, specify:
4b. Name: Mike Holder
4c. Business name
(if applicable): N.C. Department of Transportation, Division 12
4d. Street address: 1710 East Marion Street
4e. City, state, zip: Shelby, NC 28151
4f. Telephone no.: 704-480-9020
4g. Fax no.: 704-480-5401
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name: Trish Simon
5b. Business name
(if applicable): N.C. Department of Transportation, Division 12
5c. Street address: 1710 East Marion Street
5d. City, state, zip: Shelby, NC 28151
5e. Telephone no.: 704-480-9044
5f. Fax no. 704-480-5401
5g. Email address: [e-mail]
Page 2 of 12
PCN Form - Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
1 a. Property identification no. (tax PIN or parcel ID): NA
Latitude: 35.474004 Longitude: -
1b. Site coordinates (in decimal degrees): 81.181068
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: 6.5 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Hoyle Creek
proposed project:
WS-V (From source to a point 0.5 mile upstream of
2b. Water Quality Classification of nearest receiving water: Lincoln County SR 1321)
2c. River basin: Catawba
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Site 1: Existing 48-foot long 4'x 6' RCBC; Site 2: Existing 44-foot long 4'x 6' RCP; Site 3: Existing 39-foot Y x 4' RCP.
Landuse is residental. Pipes are on paved primary road.
3b. List the total estimated acreage of all existing wetlands on the property:
0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
400
3d. Explain the purpose of the proposed project:
The purpose of the proposed work is to upgrade and lengthen culverts associated with the widening of Hwy 27 east.
3e. Describe the overall project in detail, including the type of equipment to be used:
Site 1: NCDOT proposes to replace the existing 48-foot long 4'x 6' RCBC with one 120-foot long, 96" RCP on a different
alignment. The new pipe alignment will result in 50 feet loss of the old upstream channel, however, 25 feet of upstream
channel will be relocated following natural channel design principles to reconnect the stream to the new pipe. Therefore,
the total loss of the upstream channel will be 25 feet. The new pipe alignment will also result in a loss of 70 feet of
downstream channel. A 130 foot section of the downstream channel will be relocated to an 85-foot step/pool complex,
which will result in 35 feet of stream loss. The scope of work at this site results in a loss of 130 feet of stream channel.
Site 2: NCDOT proposes to replace a 44-foot long, 4'x 6' RCP with one 104-foot long, 66" RCP. The new pipe will result
in a loss of 40 feet of downstream channel (the upstream channel is non-jurisdictional). A 20-foot armored scourhole will
be constructed due to the new pipe slope of 5.2%. The scope of work at this site results in a loss of 60 feet of stream
channel.
Site 3: NCDOT proposes to replace a 39-foot X x 4' RCP with a 36-foot long, 60" RCP. An 8-foot x 8-foot long dropbox
will be constructed at the outlet of the 36-foot long, 60" RCP and a 24-foot long, 66" RCP extended from the dropbox. The
scope of work at this site results in a loss of 32 feet of stream channel.
A temporary cofferdam pumping system will be used to divert the stream flow around the construction sites as needed.
Area affected by temporary cofferdam system will be graded and restored back to pre-project conditions. All Best
Management Practice's will be utilized during the course of the project. The Project will be constructed using typical
heavy equipment (trackhoe, backhoe, etc.).
Page 3 of 12
PCN Form - Version 1.3 December 10, 2008 Version
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past? ® Yes ? No ? Unknown
Comments: Jurisdictional stream determinations made by
the Division of Water Quality
4b. If the Corps made the jurisdictional determination, what type
? Preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Division of Water Quality, 6/30/09
5. Project History
5a. Have permits or certifications been requested or obtained for ? Yes ® 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 ® No
6b. If yes, explain.
Page 4 of 12
PCN Form - Version 1.3 December 10, 2008 Version
C.
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
? Wetlands ? Streams - tributaries ? Buffers
? Open Waters ? Pond Construction
Page 5 of 12
PCN Form - Version 1.3 December 10, 2008 Version
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
W1 ? P ? T ? Yes ? Corps
? No ? DWQ
W2 ? P ? T ? Yes ? Corps
? No ? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream'impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ - non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
Site 1: Upstream- 25
Stream loss due
to fill
Upstream- Stream
relocation to 25
reconnect channel
to new pipe
S1 ®P ? T
D Hoyle Creek ® PER
? INT ® Corps
® DWQ 4.5
ownstream- 70
Stream loss due
to due to fill
Downstream-
35
Stream loss due
to stream
relocation (130
feet relocated to
85 foot step/pool
complex

S2 ? P ®T Site 1: Cofferdam
Hoyle Creek ® PER
- ® Corps
4.5
40
I bypass pumping [
I INT ® DWQ
Site 2 : Stream ? PER ® Corps 40
S3 ®P ? T loss to increase in UT to Hoyle Creek ®INT ®DWQ 1
pipe length
Page 6 of 12
PCN Form - Version 1.3 December 10, 2008 Version
Site 2:Stream loss
due to armored
scourhole 20
S4 ? P ® T Site 2:Cofferdam Ut to Hoyle Creek ? PER ® corps 1 20
bypass pumping ® INT ® DWQ
Site 3:Stream loss
S5 ®P ? T due to dropbox Ut to Hoyle Creek ? PER ® Corps 1 32
and increase in ® INT ® DWQ
pipe length

S6 ? P ®T Site 3: Cofferdam
Ut to Hoyle Creek ? PER ® corps
1 20
bypass pumping ® INT ® DWQ
3h. Total stream and tributary impacts 327
3i. Comments: REFER TO PAGE 3, SECTION 3E. FOR PROJECT IMPACT DESCRIPTION.
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Temporary T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
417. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
Page 7 of 12
PCN Form -Version 1.3 December 10, 2008 Version
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 impacts require mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse ?Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T impact required?
131 ?P?T ?Yes
[_1 No
B2 ?P?T ?Yes
E] No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts
6i. Comments:
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
At Site 1, a step pool system was designed for downstream stream relocation to dissipate energy and to connect the new pipe
outlet to the downstream channel. This measure was designed to minimize impacts by removing the 90 degree meander bend
which is located at the existing pipe outlet. At Site 2 outlet, an armored scourhole is designed to minimize erosion potential
due to the necessary slope of the new pipe. At Site 3 outlet, a dropbox is designed to minimize erosion potential.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Minimization of impacts by installing appropriate erosion control measures.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ? Yes ® 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
El Payment to in-lieu fee program
project'?
pro
? Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
Page 8 of 12
PCN Form - Version 1.3 December 10, 2008 Version
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
i
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zo
ne 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 9 of 12
PCN Form - Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a . Does the project include or is it adjacent to protected riparian buffers identified ? Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1 b . If yes, then is a diffuse flow plan included? If no, explain why.
? Yes ? No
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 90%
2b. Does this project require a Stormwater Management Plan? ? Yes ®No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Com plies with NCDOT's individual
NPDES permit NCS000250. Existing impervious is 4 acres, widening of roadway will result in a 2 acre increase of
impervious surface.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, na rrative description of the plan:
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? NA
? Phase II
3b. Which of the following locally-implemented stormwater management programs ? NSW
? USMP
apply (check all that apply):
? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review
? Coastal counties
? HOW
4a. Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply): ? Session Law 2006-246
? Other:
41b. Has the approved Stormwater Management Plan with proof of approval been
attached? ? Yes ? No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No
5b. Have all of the 401 Unit submittal requirements been met? ? Yes ? No
Page 10 of 12
PCN Form - Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation.(DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the ® Yes ? No
use of public (federal/state) land?
1b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ? Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ? Yes ? No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ®No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
The project is classified as a categorical exclusion project which has low potential for cumulative/indirect impacts and will
not result in additional development which could impact water quality.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Page 11 of 12
PCN Form - Version 1.3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a . Will this project occur in or near an area with federally protected species or ? Yes ® No
habitat?
5b . Have you checked with the USFWS concerning Endangered Species Act ? Yes ® No
impacts?
E] Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted. ? Asheville
5d . What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC Natural Heritage Program database.
6. Essential Fish Habitat (Corps Requirement)
6a . Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No
6b . What data sources did you use to determine whether your site would impact Essential Fish Habitat?
No salt marshes, oyster reefs, or seagrass beds in the vicinity of the project.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a . Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation ? Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
71b . What data sources did you use to determine whether your site would impact historic or archeological resources?
The project has been reviewed by and approved by NCDOT Cultural Resources Specialist. No further survey is required.
8. Flood Zone Designation (Corps Requirement)
8a . Will this project occur in a FEMA-designated 100-year floodplain? ? Yes ®No
81b . If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? FEMA FIRM panel number: 3710364300J
M L. NWder- 11-/D-Dol
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)
Page 12 of 12
PCN Form - Version 1.3 December 10, 2008 Version
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NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division: I? County: I inroln Project ID: W-4712
River Basin: Catawba Bridge No: NA
Route: Highway 27 East Stream: Hoyle Creek and two
unnamed tributaries to Hoyle Creek
Water Quality Criteria:
Yes No
Stream Crossing Blue Line On USGS r r
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WS 11,111 OR IV, Crossing Within 0.5mi of W.S. Critical Area ? r
Roadway Criteria:
Route Designation-
Yes No
Arterial Urban r r
Arterial Rural R- U
Additional Site Information:
Yes No
Is a Hazardous Spill Basin Required? r r
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997).

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