20201823 Ver 1_ePCN Application_20210112

DWR
mrlslon of Water Resources
Pre -Construction Notification (PCN) Form
October 26, 2020 Ver 3.3
Initial Review
Has this project met the requirements for acceptance in to the review process?*
6 Yes
r No
Is this project a public transportation project?*
C Yes 6 No
Change only if needed.
BIMS # Assigned
20201823
Is a payment required for this project?*
Version#*
1
r No payment required
What amout is owed?*
r Fee received
r $240.00
6 Fee needed - send electronic notification
r $570.00
Reviewing Office *
Select Project Reviewer*
Raleigh Regional Office - [phone]
Stephanie Goss:eads\sagoss
Information for Initial Review
1a. Name of project:
Bellamy Lake Road Distribution Relocation
1a. Who is the Primary Contact?*
Jeremy Meads
1b. Primary Contact Email:*
[e-mail]
Date Submitted
1/12/2021
Nearest Body of Water
Fishing Creek
Basin
Tar -Pamlico
Water Classification
WS-N; NSW
Site Coordinates
Latitude: Longitude:
36.155307-77.751639
1c. Primary Contact Phone:*
[phone]
Pre -Filing Meeting Information
ID# Version
20201823 1
Pre -fling Meeting or Request Date*
12/8/2020
Attach documentation of Pre -Filing Meeting Request here:*
DWR Pre -Filing Meeting Request Form.pdf 57.17KB
20201823 Ver 1_PreFiling Meeting Not Required Email_20210101.pdf 373.68KB
A. Processing Information
County (or Counties) where the project is located:

Halifax
Nash
Is this a NCDMS Project
r Yes r No
Is this project a public transportation project?*
r Yes r No
1a. Type(s) of approval sought from the Corps:
W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
W Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
r Yes
r No
1b. What type(s) of permit(s) do you wish to seek authorization?
W Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Nationwide Permit (NWP) Number: 12 - Utility Lines
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
r 401 Water Quality Certification - Regular R 401 Water Quality Certification - Express
r Non-404 Jurisdictional General Permit (— Riparian Buffer Authorization
r Individual Permit
1e. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification: r Yes r No
For the record onlyfor Corps Permit: r Yes r No
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
r Yes r No
B. Applicant Information
1d. Who is applying for the permit?
r Owner 9 Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
Multiple See Attached Landowner Information List
2b. Deed book and page no.:
2c. Responsible party:

2d.Address
Street Address
Multiple - See Attached Landowner Information List
Address Line 2
CRY
State / Province / Fbgion
Enfield
NC
Fbstal / Zip Code
Country
27823
United States
2e. Telephone Number:
2f. Fax Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Piedmont Natural Gas
3b. Business Name:
3c.Address
Street Address
105 Impact Boulevard
Address Line 2
city
State / Rovince / Fbgion
Elizabeth City
North Carolina
Postal / Zip Code
Country
27909
United States
3d. Telephone Number:
3e. Fax Number:
[phone]
3f. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Patrick Meier
4b. Business Name:
Burns & McDonnell
4c.Address
Street Address
7201 Glen Forest Drive
Address Line 2
Suite 100
City
State / Province / Rion
Richmond
Virginia
Fbstal / Zip Code
Country
23226
United States
4d. Telephone Number: 4e. Fax Number:
[phone]
4f. Email Address:*
[e-mail]
Agent Authorization Letter*
BELLAMY_LAKE_AGENT_AUTHORIZATION_FORM.pdf 105.68KB
C. Project Information and Prior Project History U
1. Project Information
1b. Subdivision name:
(rf appropriate)
1c. Nearest municipality/ town:
Enfield, NC

2. Project Identification
2a. Property Identification Number:
2c. Project Address
Street Address
Address Line 2
cty
Postal / Zip Code
3. Surface Waters
3a. Name of the nearest body of water to proposed project:"
Fishing Creek
3b. Water Resources Classification of nearest receiving water:*
WS-IV; NSW
3c. What river basin(s) is your project located in?*
Tar -Pamlico
3d. Please provide the 12-digit HUC in which the project is located.
030201020503
4. Project Description and History
2b. Property size:
State / Province / Pegion
Country
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:*
Piedmont Natural Gas (PNG) is proposing to construct appro>mately 3,400 feet of 8-inch mediurrmdense polyethylene (MDPE) natural gas pipeline to avoid a conflict between the
existing pipeline route and a proposed North Carolina Department of Transportation (NCDOT) road maintenance project along Bellamy Lake Road. The Project is east of Interstate 95
(1-95), west of US 301 (Route 301), south of NC 481 (Route 481), and is accessible via Bellamy's Mill Road (Route 1518).
The proposed pipeline crosses various land use types consisting primarily of mixed hardwood -pine forest, forested wetlands, upland cutover, and agricultural areas.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
4d. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
WDR A-2.pdf
977.38KB
4e. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
WDR A-3.pdf 1.21 MB
4f. List the total estimated acreage of all existing wetlands on the property:
2.40
4g. List the total estimated linear feet of all existing streams on the property:
601.50
4h. Explain the purpose of the proposed project:*
The purpose of this project is to re -locate a portion of an existing natural gas pipeline to avoid a conflict between the existing pipeline route and a proposed North Carolina Department
of Transportation (NCDOT) road maintenance project along Bellamy Lake Road.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The Project will consist of installing approximately 3,400 feet of 8-inch MDPE natural gas distribution pipeline within a proposed 20 foot wide permanent easement with begin west of
Fishing Creek and south of Bellamy Lake Road and continues east for approximately 2,500 feet, crosses beneath Fishing Creek twice via horizontal direction drilling (HDD), and
continues north for approximately 900 feet where it ties in with the existing pipeline at Bellamy Lake Road.
Potential construction activities associated with the Project may include clearing, grubbing, and construction of pipeline infrastructure. Construction will involve the use of typical heavy
construction equipment (e.g., excavators, dozers, scrapers, side booms) and will be executed in compliance with all required permits and regulatory conditions.
4j. Please upload project drawings for the proposed project.
1.7.1_MX5694600_20201016_90 % DesignSubmittal.pdf 25.82MB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No O Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r N/A
Corps AID Number:

5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Patrick Meier
Agency/Consultant Company: Burns & McDonnell
Other:
5d1. Jurisdictional determination upload
Bellamy Lake Road Wetland Report 010421.pdf 6.47MB
6. Future Project Plans
6a. Is this a phased project?*
t^ Yes r No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed projector related activity?
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
W Wetlands r Streams -tributaries V Buffers
r Open Waters r Pond Construction
2. Wetland Impacts
2a1 Reason (?)
2b. Impact type * (?)
2c. Type of W.*
2d. W. name *
2e. Forested *
2f. Type of
2g. Impact
Jurisdicition*(?)
area
W-01
Permanent Conversion
P
ffornland Hardwood Forest
W-01
Yes
Corps
0.083
(acres)
W-02(PFO)
Permanent Conversion
P
ffornland Hardwood Forest
W-02
Yes
Corps
0.008
(acres)
W-02(PSS)
Permanent Convresion
P
Unknown
W-02
�
Corps
0.025
(acres)
2g. Total Temporary Wetland Impact
2g. Total Permanent Wetland Impact
0.000
0.116
2g. Total Wetland Impact
0.116
2h. Comments:
Impacts to PFO and PSS within the permanent maintenance corridor will be considered permanent conversion impacts to PEM wetlands.
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin(s)?
Check all that apply.
r Neuse
PF Tar -Pamlico
r Catawba
r Randleman
r Goose Creek
r Jordan Lake
F Other
6b. Impact Type 6c. Per or Temp ream name 6e. Buffer mitigation required? 6f. Zone 1 impact 6g. Zone 2 impact 6d. St
HDD and Permanent Maintenance Easement
P
Fishing Creek
No
2,440
1,569
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 2,440.00 1,569.00

Zone 1 Zone 2
Total combined buffer impacts: 2,440.00 1,569.00
61. Comments:
Supporting Documentation
Wetland Impact Figure_20201123.pdf 1 MB
E. Impact Justification and Mitigation t,
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The design of the Project makes an effort to avoid and minimize impacts by narrowing the temporary work area and permanent maintenance
easement as much as possible. The proposed route was designed using the wetland delineation to minimize impacts where possible.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Portions of the pipeline will be installed using horizontal directional drilling (HDD) to avoid impacts to Fishing Creek. Construction matting will be used
within the temporary work easement to minimize impacts and the Project will follow an approved erosion and sediment control plan.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
r Yes r No
2c. If yes, mitigation is required by (check all that apply):
r DWR W Corps
2d. If yes, which mitigation option(s) will be used for this project?
r' Mitigation bank r Payment to in -lieu fee r Permittee Responsible
program Mitigation
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the INC Riparian Buffer Protection Rules?
r Yes r No
What type of SCM are you providing?
r Level Spreader
r Vegetated Conveyance (lower SHWT)
r Wetland Swale (higher SHWT)
r Other SCM that removes minimum 30 % nitrogen
W Proposed project will not create concentrated stormvrater flow through the buffer
Diffuse Flow Documentation
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
r Yes r No
Comments:
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes r No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15ANCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
r Yes r No
i

3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
C Yes r No
3b. If you answered "no," provide a short narrative description.
Project consists of a pipeline re-route and is not being completed for future development considerations.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r Nor N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
r Yes C No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
r Yes r No
5e. Is this a DOT project located within Division's 1-8?
r Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r Yes r No
r Unknown
51. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS IPaC; USFWS Raleigh Office Consultation
Consultation Documentation Upload
202012008_LTRSNT_FWS_BurnsMcDonnell_PiedmontNaturalGasBellamyLakeRoadDistributionRelocation.pdf 160.33KB
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NOAA EFH Viewer
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 status?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
NC HPOWEB; Consultation Request Letter submitted to SHPO (attached), awaiting response from SHPO. Will provide upon receipt.
7c. Historic or Prehistoric Information Upload
PING Bellamy Lake Road SHPO consultation_12072020.pdf 3.32MB
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
r Yes r No
8b. If yes, explain how project meets FEMA requirements:
No above ground structures will be constructed within a FEMA designated floodplain as a result of the Project. Additionally, Project team is
coordinating with local County authorities to assure Project maintains compliance with FEMA and local flooplain requirements.

8c. What source(s) did you use to make the floodplain determination?*
FEMA National Flood Hazard Map
Miscellaneous
Comments
Unable to locate mitigation bank or in -lieu fee site that covers Project. Would prefer to consult with Corps of Engineers rep for additional options for impact mitigation.
Miscellaneous attachments not previously requested.
Property Owner List for Bellamy Lake.pdf
Signature
F% By checking the box and signing below, I certify that:
14.89KB
The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief; and
• 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 have given true, accurate, and complete information on this form;
• I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• 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 PCN form.
Full Name:
Patrick K. Meier
Signature
irk C�rlw-
Date
1/12/2021

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID:
STREET ADDRESS: Pipeline corridor southeast of Bellamy Lake in Halifax and Nash Counties,
KInrfh (-Arnlina
Please print:
Property Owner: Piedmont Natural Gas (holder of easement)
Property Owner: Jeremy Meads (Sr. Distribution Project Specialist with Piedmont Natural Gas)
The undersigned, registered property owners of the above noted property, do hereby authorize
Patrick K. Meier
(Contractor / Agent)
of Burns & McDonnell
(Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance
of this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
105 Impact Boulevard, Elizabeth City, NC 27909
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Authorized Signature
Date: 1 /12/2021 Date: 1/5/2020

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Scale in Feet Counties, North Carolina
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nergy,

United States Department of the Interior
FISH AND WILDLIFE SERVICE
Raleigh ES Field Office
551-F Pylon Drive
Raleigh, North Carolina 27606
December 8, 2020
Patrick Meier
Burns & McDonnell
7201 Glen Forest Drive, Suite 100
Richmond, VA 23226
Re: Piedmont Natural Gas Bellamy Lake Road Distribution Relocation — Halifax & Nash Co.
Dear Mr. Meier:
This letter is to inform you that the Service has established an on-line project planning and
consultation process which assists developers and consultants in determining whether a
federally -listed species or designated critical habitat may be affected by aproposed project. For
future projects, please visit the Raleigh Field Office's project planning website at
https://www.fws.gov/raleigh/pp.html. If you are only searching for a list of species that may be
present in the project's Action Area, then you may use the Service's Information, Planning, and
Consultation System (IPaC) website to determine if any listed, proposed, or candidate species
may be present in the Action Area and generate a species list. The IPaC website may be viewed
at https://ecos.fws.gov/ipac/. The IPaC web site contains a complete and frequently updated list
of all endangered and threatened species protected by the provisions of the Endangered Species
Act of 1973, as amended (16 U.S.C. 1531 et seq.)(Act), a list of federal species of concern' that
are known to occur in each county in North Carolina, and other resources.
Section 7 of the Act requires that all federal agencies (or their designated non-federal
representative), in consultation with the Service, insure that any action federally authorized,
funded, or carried out by such agencies is not likely to jeopardize the continued existence of any
federally -listed endangered or threatened species. A biological assessment or evaluation may be
prepared to fulfill that requirement and in determining whether additional consultation with the
Service is necessary. In addition to the federally -protected species list, information on the
species' life histories and habitats and information on completing a biological assessment or
'The term "federal species of concern" refers to those species which the Service believes might be in need of
concentrated conservation actions. Federal species of concern receive no legal protection and their designation
does not necessarily imply that the species will eventually be proposed for listing as a federally endangered or
threatened species. However, we recommend that all practicable measures be taken to avoid or minimize adverse
impacts to federal species of concern.

evaluation and can be found on our web page at http://www.fws.gov/raleigh. Please check the
web site often for updated information or changes.
If your project contains suitable habitat for any of the federally -listed species known to be
present within the county where your project occurs, the proposed action has the potential to
adversely affect those species. As such, we recommend that surveys be conducted to determine
the species' presence or absence within the project area. The use of North Carolina Natural
Heritage program data should not be substituted for actual field surveys.
If you determine that the proposed action may affect (i.e., likely to adversely affect or not likely
to adversely affect) a federally -protected species, you should notify this office with your
determination, the results of your surveys, survey methodologies, and an analysis of the effects
of the action on listed species, including consideration of direct, indirect, and cumulative effects,
before conducting any activities that might affect the species. If you determine that the proposed
action will have no effect (i.e., no beneficial or adverse, direct or indirect effect) on federally
listed species, then you are not required to contact our office for concurrence (unless an
Environmental Impact Statement is prepared). However, you should maintain a complete record
of the assessment, including steps leading to your determination of effect, the qualified personnel
conducting the assessment, habitat conditions, site photographs, and any other related articles.
With regard to the above -referenced project, we offer the following remarks. Ourcomments are
submitted pursuant to, and in accordance with, provisions of the Endangered Species Act.
Based on the information provided and other information available, it appears that the proposed
action is not likely to adversely affect any federally -listed endangered or threatened species, their
formally designated critical habitat, or species currently proposed for listing under the Act at
these sites. We believe that the requirements of section 7(a)(2) of the Act have been satisfied for
your project. Please remember that obligations under section 7 consultation must be
reconsidered if: (1) new information reveals impacts of this identified action that may affect
listed species or critical habitat in a manner not previously considered; (2) this action is
subsequently modified in a manner that was not considered in this review; or, (3) a new species
is listed or critical habitat determined that may be affected by the identified action.
However, the Service is concerned about the potential impacts the proposed action might have
on aquatic species. Aquatic resources are highly susceptible to sedimentation. Therefore, we
recommend that all practicable measures be taken to avoid adverse impacts to aquatic species,
including implementing directional boring methods and stringent sediment and erosion control
measures. An erosion and sedimentation control plan should be submitted to and approved by
the North Carolina Division of Land Resources, Land Quality Section prior to construction.
Erosion and sedimentation controls should be installed and maintained between the construction
site and any nearby down -gradient surface waters. In addition, we recommend maintaining
natural, vegetated buffers on all streams and creeks adjacent to the project site.
The North Carolina Wildlife Resources Commission has developed a Guidance Memorandum (a
copy can be found on our website at (http://www.fws.gov/raleigh) to address and mitigate
secondary and cumulative impacts to aquatic and terrestrial wildlife resources and water quality.

We recommend that you consider this document in the development of your projects and in
completing an initiation package for consultation (if necessary).
We hope you find our web page useful and informative and that following the process described
above will reduce the time required, and eliminate the need, for general correspondence for
species' lists. If you have any questions or comments, please contact John Ellis of this office at
[phone] ext. 26.
Sincerely,
Pete Benj min
Field Supervisor

BURNS �MEDONNELL
December 7, 2020
Ms. Renee Gledhill -Earley
State Historic Preservation Office
4617 Mail Service Center
Raleigh, NC 27699-4617
*Submit electronically to SHPO at [e-mail]
Re: Request for Consultation under Section 106
Piedmont Natural Gas Bellamy Lake Road Distribution Relocation Project
Halifax and Nash Counties, North Carolina
Dear Ms. Gledhill -Earley:
Burns & McDonnell Consultants, Inc. (Burns & McDonnell), on behalf of Piedmont Natural Gas
(PNG), has prepared the following request for consultation under Section 106 of the National
Historic Preservation Act for the proposed Bellamy Lake Road Distribution Relocation Project in
Halifax and Nash Counties, North Carolina (Attachment A: Figures A-1 and A-2). The proposed
Area of Potential Effects (APE) is located at 36.154729,-77.750017 and encompasses all
proposed Project components discussed below. The APE totals approximately 5.65 acres.
The proposed Project would include the replacement of approximately 3,400 linear feet of 8-inch
medium -dense polyethylene (MDPE) natural gas pipeline within a new 20-foot-wide easement
(Attachment A: Figure A-3). Approximately 1,750 feet would be constructed via open cut
methods and approximately 1,650 feet via Horizontal Directional Drill (HDD) methods
approximately 22 feet and 24 feet beneath Fishing Creek. Construction will require
approximately 1.3 acres of temporary workspace. The Project will be accessed by approximately
4,300 feet of extant access roads (Attachment A: Figure A-3). No grading or subsurface impacts
are anticipated from use of the access roads.
The proposed limit of disturbance (LOD) is shown in the accompanying LOD kmz. The Project
is intended to re-route a portion of an existing natural gas pipeline that is in conflict with a
proposed North Carolina Department of Transportation (NCDOT) project along Bellamy Lake
Road. The Project is being permitted under a U. S. Army Corps of Engineers (USACE)
Nationwide Permit 12. Therefore, compliance with Section 106 is required.
BACKGROUND REVIEW
On October 14, 2020, Burns & McDonnell received record search results from the North
Carolina Office of the State Archaeologist (OSA) for the Project. Burns & McDonnell also
reviewed the SHPO's HPOWEB GIS service application online for non -archaeological historic -
age resources that intersect or are adjacent to the APE on October 15, 2020.
9400 Ward Parkway \ Kansas City, MO 64114
0 816-333-9400 \ F 816-333-3690 \ burnsmcd.com

BURNS �MEDONNELL
Ms. Renee Gledhill -Earley
State Historic Preservation Office
December 7, 2020
Page 2
There are no previously recorded archaeological sites within 1 mile of the APE (Attachment A:
Figure A-4). No archeological sites are recorded within the APE, but the APE has not been
previously surveyed. The Project is located on a bend in Fishing Creek. Given the proximity to
water, the APE has potential to contain previously unrecorded archaeological sites.
Five historic -age resources were identified within an approximately 1-mile radius; none intersect
the APE (Table 2; Attachment A: Figure A-4). The NRHP-listed Bellamy's Mill is located
approximately 1,200 feet east of the APE along Fishing Creek. No impacts to the mill or other
previously recorded resources are anticipated in association with the proposed Project. A review
of historic -age maps and aerial photographs available online did not identify any potential
historic -age architectural resources within the APE (USGS 2020, NETR 2020).
Table 2: Previously Recorded Historic -Age Resources
Resource
Intersects
Number
Resource Name
Description
NRHP Status
APE?
HX0246
Lake Shore Farm
-
Surveyed only; Gone?
No
Overseer's House
HX0248
Joe Garrett House
-
Surveyed only
No
(Undermined)
NS0003
Bellamy's Mill
1859 stone grist mill
Listed
No
NS0533
House
-
Surveyed only
No
(Undermined
NS0897
Kinchen Carter
1850 Greek Revival
Study List (May be
No
Taylor House
house
significant; Further
study is needed to
determine eligibility)
Source: HPOWEB 2020.
SUMMARY AND RECOMMENDATIONS
The background review identified one NRHP-listed grist mill and 3 unevaluated historic -age
resources within one mile of the APE. No cultural resources have been previously recorded
within the APE, but the APE has not been previously surveyed.
Burns & McDonnell, on behalf of PNG, requests your office's input regarding cultural resources
survey requirements under Section 106 for the proposed Bellamy Lake Road Distribution
Relocation Project. A USACE Nationwide Permit 12 is anticipated for the Project, and the

BURNS �MEDONNELL
Ms. Renee Gledhill -Earley
State Historic Preservation Office
December 7, 2020
Page 3
USACE has previously requested that Piedmont Natural Gas should follow your
recommendations regarding any additional cultural resources surveys.
Sincerely,
Shelly Wunderlich
Senior Cultural Resources Specialist
Attachment A — Figures
cc: Anthony McMullan, Burns & McDonnell
Steve Cahoon, PNG
Tom Morris, PNG
REFERENCES
Nationwide Environmental Title Research (NETR)
2020 Historic Aerials. Electronic document, https://www.historicaerials.com/viewer,
accessed October 15, 2020.
U. S. Geological Survey (USGS)
2020 USGS Historical Topographic Map Explorer. Electronic document,
https:Hlivingatlas.arcgis.com/topoexplorer, accesses October 15, 2020.

0
0
c
r
m
0
0
Y
Bella_my'Lake Rd '
0 Area of Potential Effects
NORTH
BURNS
700 350 0 700 `MSDONNELL"
Scale in Feet
E
WIN
Figure A-1
Proposed Project Area
Bellamy Lake Road
Distribution Relocation
Piedmont Natural Gas

O
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M
0
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a
0 Area of Potential Effects Figure A-2
Quadrangle Boundary NORTH Proposed Project Area
BURNS 2,000 1,000 0 2,000 ` Bellamy y Lake Road
Distribution Relocation
Scale in Feet Piedmont Natural Gas
Source: Esri, and Burns & McDonnell Consultants. Issued: 11/4/2020

x//s^
1 i
15
Its
r '
J r-i
1 0 R T H
38V
� /X � Ip0 �
Area of Potential Effects HDD Figure A-4
;---- j NORTH Records Search Results
One -Mile Buffer ,
BURNS Bellam Lake Road
A Historic -Age Resource 0 1,000 2,000 `M`DONNELL" Y
Distribution Relocation
NRHP Property Scale in Feet Piedmont Natural Gas
Source: Esri, NCHPO, and Burns & McDonnell Consultants. Issued: 11/4/2020

e o.
Bellamy
LANDOWNER INFORMATION
NumberProject Tract
Landowner Name
County
State
Street Address City, State Zip Street Address City, State Zip Phone Number
Phone Number
Email
County PIN
1002.00
Tim W. & Kay W. Fisher
Halifax
NC
11735 Watson Seed Whitakers, NC Bellamy Lake Rd Halifax, NC [phone]
3867-00-77-2124
Farm Rd. 27891
1003.00
Frederick M. & Elaine T.
Halifax
NC
433 Dunn Lane
Enfield, NC 27823
Bellamy Lake Rd
Halifax, NC
(252)-445-3353
3877-00-08-7245
Dunn
1004.00
Rocky Road Farms, LLC.
Nash
NC
5616 Potters Clay
Rocky Mountain,
Bellamy Mill Rd
Nash, NC
[phone]
386700864556
County
CT
NC 27804
Mozingo Willis Conrad
1004AR1
Elsie, Revocable Living
Nash
NC
6498
Farmville, NC
Bellamy Mill Rd
Nash, NC
(252)-258-4852
387700034622
County
Stantonsburg Rd
27828
Trust
Mozingo Willis Conrad
Nash
6498
Farmville, NC
1004AR2
Elsie, Revocable Living
NC
Bellamy Mill Rd
Nash, NC
(252)-258-4852
387700057586
County
Stantonsburg Rd
27828
Trust

ID#* 20201823
Version* 1
Regional Office * Raleigh Regional Office - [phone]
Reviewer List* Stephanie Goss
Pre -Filing Meeting Request submitted 12/1/2020
Contact Name* Patrick Meier
Contact Email Address* [e-mail]
Project Name* Bellamy Lake Road Distribution Relocation
Project Owner* Piedmont Natural Gas
Project County* Halifax
Owner Address: Street Address
4720 Piedmont Row Drive
Address Line 2
aty State / Province / Pegion
Charlotte North Carolina
Postal / Zip axle Country
28210 United States
Is this a transportation project?* r Yes r No
Type(s) of approval sought from the DWR:
* 401 Water Quality Certification - W 401 Water Quality Certification -
Regular Express
* Individual Permit F Modification
F Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes (-- No
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below.*

PNG is proposing to construct approximately 3,400 feet of 8" mediurrr
dense polyethylene (MDPE) natural gas pipeline in order to avoid a conflict
between the existing pipeline route and a proposed road maintenance
project by the North Carolina Department of Transportation (NCDOT) along
Bellamy Lake Road. The Project is located east of Interstate 95 (1-95), west
of US 301 (Route 301), south of NC 481 (Route 481), and is accessible via
Bellamy's Mill Road (Route 1518).
The Project will begin west of Fishing Creek and south of Bellamy Lake
Road and will proceed to the east for approximately 2,500 feet and will
cross beneath Fishing Creek twice via horizontal direction drilling (HDD).
The route will then proceed to the north for approximately 900 feet where it
will terminate at the tie in with the existing pipeline at Bellamy Lake Road.
The pipeline will cross various land use types consisting primarily of mixed
hardwood pine forest, forested wetlands, upland cutover, and agricultural
areas.
Please give a couple of dates you are available for a meeting.
12/14/2020
12/15/2020
12/16/2020
12/17/2020
12/4/2020
Please attach the documentation you would like to have the meeting about.
BellamyLakeRdFigures.pdf 1.79MB
pdf only
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
1 understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
I also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature
Submittal Date 12/1/2020

Strickland, Bev
From: [e-mail]
Sent: Friday, January 1, 2021 12:00 AM
To: [e-mail]
Cc: Goss, Stephanie
Subject: Pre -Filing Meeting is not needed for Bellamy Lake Road Distribution Relocation -
20201823 Ver 1
The North Carolina Division of Water Resources has received the Pre -Filing Meeting Request Form for
Bellamy Lake Road Distribution Relocation that you submitted on 12/1/2020 12:49 PM. The ID number for that
project is 20201823, Version 1.
It has been decided that no meeting is needed for this project.
Project file link: https:Hedocs.deq.nc.gov/WaterResources/Browse.aspx?dbid=0&startid=1381692
When you submit your application please upload a copy of the attached document in this email.
This email was automatically generated by Laserfiche workflow. Please do not respond to this email address, as
responses are not monitored.