20120530 Ver 1_Application_20120531

STATE OF NORTH CAROLINA
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DEPARTMENT OF TRANSPORTATION q�q�
BEVERLY EAVES PERDUE EUGENE A TI 7R
GOVERNOR SECRETARY
May 25 2012
Ms Liz Hair
Asheville Regulatory Field Office
US Army Corps of Engineers,) 67) 0
151 Patton Avenue Room 208
Asheville North Carolina 28801 5006
SUBJECT Emergency Pipe Replacement on SR 2644 (Appian Way) Cleveland County
Dear Ms Hair
The North Carolina Department of Transportation requests authorization to replace a failing pipe
on SR 2644 (Appian Way) in Cleveland County NCDOT proposes to replace a 60 foot long,
84" CMP with a 70 foot long, 96" CMP Five feet of riprap will be used at the pipe inlet and
outlet for structure stabilization There appears to have voids between the failing pipe and the
roadway causing the road ground /road to sink This is considered a safety hazard to the traveling
public therefore the project is considered an emergency project and construction commenced
immediately The increase in pipe length is necessary to provide an adequate road shoulder
The pipe inlet end of the new pipe will be shifted to better align the pipe and the channel The
new pipe will be on is a steep slope ( -4 %) if buried per regulation therefore it is proposed that
the new pipe be placed at existing streambed grade Due to the existing site conditions,
NCDOT requests a waiver from the Regional Conditions 2(b) (e) permit depth specification
for the construction of this project Temporary cofferdams/bypass pumping will be used to
divert the stream around the construction site as needed Areas affected by temporary cofferdam
system will be restored to pre project conditions
The total scope of the work will result in 20 feet of permanent impacts to an unnamed tributary to
Buffalo Creek (Kings Mountain Reservoir) which is classified as a WS III watershed by the
Division of Water Quality
The project area is within the critical watershed area however SR 2644 is not classified as a
rural or urban arterial Hazardous spill basins are not required Enclosed is the hazardous spill
basin checklist 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 There will be no effect
on any for historical structures
Post Office Box 47 Shelby North Carolina 28151 0047

SR 2644 Appian Way
Page 2
May 25 2012
This office has conducted a GIS and field survey for threatened and endangered species in the
vicinity of the project The Natural Heritage Program records document the nearest dwarf
flowered heartleaf location approximately 10 mile northwest of the proposed project 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 sprmgheads The project area is forested but
suitable habitat is not present No impact on the species is anticipated
I have enclosed a pre construction notification for a NW #14 sketches of planned activities and
location maps relative to the project
Project information for the 401 Automated Payment Procedure is as follows
• Work order number 150455 55120005 12 202311 3126
• TIP# NA
• 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
Trish Simon
Division 12 Environmental Supervisor
Enclosures
cc Brian Wrenn Division of Water Quality Transportation Permitting Unit
Polly Lespmasse Division of Water Quality Mooresville Regional Office

O�O� W A
T F9pG
� r
Office Use Only
Corps action ID no
DWQ project no
Form Version 1 3 Dec 10 2008
Page 1 of 11
PCN Form — Version 1 3 December 10 2008 Version
Pre - Construction Notification PC Form
A Applicant Information
1
Processing
la
Type(s) of approval sought from the
Corps
®Section 404 Permit ❑Section 10 Permit
1b Specify Nationwide Permit (NWP) number 14 or General Permit (GP) number
1c:
Has the N WP 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
1 e
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 1h
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
SR 2644 (Appian Way)
2b
County
Cleveland
2c
Nearest municipality / town
Shelby
2d
Subdivision name
2e
NCDOT only T I P or state
project no
12B 202311
3
Owner Information
3a
Name(s) on Recorded Deed
NC DOT Right of Way
3b
Deed Book and Page No
3c Responsible Party (for LLC i f
applicable)
3d
Street address
3e
City state zip
3f
Telephone no
3g
Fax no
3h
Email address
Page 1 of 11
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
Busines s 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
mholder @ncdot gov
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
tsiimon @ncdot gov
Page 2 of 11
PCN Form — Version 1 3 December 10 2008 Version

B Project Information and Prior Project History
1 Property Identification
1a Property identification no (tax PIN or parcel ID)
NA
lb Site coordinates (in decimal degrees)
Latitude 35 304339 Longitude 81 4712
(DD DDDDDD) ( DD DDDDDD)
1c Property size
<0 10 acres
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
UT to Buffalo Creek (Kings Mountain Reservoir)
proposed project
2b Water Quality Classification of nearest receiving water
WS III
2c River basin
Broad
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
Failing 60 84 CMP on paved dead end road Landuse is residential and forested
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
100 feet
3d Explain the purpose of the proposed project
The purpose of the proposed work is to replace the failing pipe for the safety of the travelling public
3e Describe the overall project in detail including the type of equipment to be used
NCDOT proposes to replace a 60 foot long 84 CMP with a 70 foot long 96 CMP Five feet of nprap will be used at the
pipe inlet and outlet for structure stabilization There appears to have voids between the failing pipe and the roadway
causing the road ground /road to sink This is considered a safety hazard to the traveling public therefore the project is
considered an emergency project and construction commenced immediately The increase in pipe length is necessary to
provide an adequate road shoulder The pipe inlet end of the new pipe will be shifted to better align the pipe and the
channel The new pipe will be on is a steep slope ( -4 %) if buried per regulation therefore it is proposed that the new
pipe be placed at existing streambed grade The Project will be constructed using typical heavy equipment (trackhoe
backhoe etc )
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 determination made by
Division 12 DEO
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
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
Page 3 of 11
PCN Form — Version 1 3 December 10 2008 Version

6 Future Project Plans
6a Is this a phased project? ❑ Yes ® No
6b If yes explain
Page 4 of 11
PCN Form — Version 1 3 December 10 2008 Version

C Proposed Impacts Inventory
1 Impacts Summary
la Which sections were completed below for your project (check all that apply)
❑ Wetlands ® 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 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)
S1 ®P ❑ T
Increase in pipe
Ut to Buffalo
® PER
® Corps
35
10
length
Creek
❑ INT
® DWQ
S2 ®P ❑ T
Riprap for
structure
Ut to Buffalo
® PER
® Corps
35
10
stabilization
Creek
❑ INT
® DWQ
S3 ❑ P ®T
Cofferdam bypass
Ut to Buffalo
® PER
® Corps
35
20
pumping
Creek
❑ INT
® DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h Total stream and tributary impacts
20
31 Comments Permanent Impacts
Page 5 of 11
PCN Form — Version 1 3 December 10 2008 Version

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
4f Total open water impacts
4g Comments
5 Pond or Lake Construction
If pond or lake construction proposed then complete the chart below
5a I 5b I 5c 5d 5e
Pond ID I Proposed use or purpose
number of pond
Wetland Impacts (acres) I Stream Impacts (feet) I Upland
Flooded I Filled I Excavated I Flooded I Filled I Excavated I Flooded
P1
P2
5f Total
5g Comments
5h Is a dam high hazard permit required
❑ Yes ❑ No If yes permit ID no
51 Expected pond surface area (acres)
51 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 any impacts require mitigation then you MUST fill out Section D of this form
6a
Project is in which protected basin?
6b 6c 6d
Buffer impact
number— Reason
Permanent (P) or for
Temr)orary (T) impact
B1 [I PMT
B2 ❑P ❑T
B3 ❑P ❑T
61 Comments
❑ Neuse ❑ Tar Pamlico ❑ Other
❑ Catawba ❑ Randleman
6e 6f 6g
Buffer
Stream name mitigation
required?
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
6h Total buffer impacts
Zone 1 impact ( Zone 2 impact
(square feet) (square feet)
Page 6 of 11
PCN Form — Version 1 3 December 10 2008 Version

D Impact Justification and Mitigation
1 Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
Due to slope it is proposed that the new pipe to be placed on grade rather than buried per regulation to prevent upstream
stream destabilization
lb Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
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?
❑ Yes ® No
2b If yes mitigation is required by (check all that apply)
❑ DWQ ❑ Corps
2c If yes which mitigat ion option will be used for this
projects
❑ Mitigation bank
El Payment to in lieu fee program
❑ Permittee Responsible Mitigation
3 Complete if Using a Mitigation Bank
3a Name of Mitigation Bank
3b Credits Purchased (attach receipt and letter)
Type
Quantity
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
Page 7 of 11
PCN Form — Version 1 3 December 10 2008 Version

6 Buffe^ 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
Zone
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 8 of 11
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?
lb
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?
0%
2b
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c
If this project DOES NOT require a Stormwater Management Plan explain why Complies with NCDOT s individual
NPDES permit NCS000250
2d
If this project DOES require a Stormwater Management Plan then provide a brief narrative 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 governments jurisdiction is this project?
NA
❑ Phase II
❑ NSW
3b
Which of the following locally implemented stormwater management programs
❑ 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
❑ HQW
4a
Which of the following state implemented stormwater management programs apply
❑ ORW
(check all that apply)
❑ Session Law 2006 246
❑ Other
4b
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
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 9 of 11
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?
lb
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)
Pipe failure /road
sinking
due to voids was considered an emergency project which required immediate repair
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 a minimum criteria 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
No wastewater generated from project
Page 10 of 11
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:1 Raleigh
5c If yes ind icate 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 located in vicinity of 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)?
7b What data sources did you use to determine whether your site would impact historic or archeological resources?
The State Historic Preservation office resources and the National Register of Historic Places were reviewed for historic
sites in the vicinity of the project however the pipe replacement project occurs within a previously impacted area
(NCDOT Right of Way)
8 Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA designated 100 year floodplain?
❑ Yes ® No
8b If yes explain how project meets FEMA requirements
8c What source(s) did you use to make the floodplain determination? FEMA FIRM panel number 3710256700E
/- � o(-e/
Applicant/Agents Printed Name
Date
Applicant/Agents Signature
(Agents signature is valid only if an authorization letter from the applicant
is provided
Page 11 of 11
PCN Form — Version 1 3 December 10 2008 Version

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Cleveland County
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Name WACO Location 035 3043390 N 081 4712595 W
Date 5/22/2012 Caption Emergency Pipe Replacement SR 2644 (Appian Way) UT to
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NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division 17 County Cleveland-Project ID 12B 023011
River Basin Broad Bridge No NA
Route Pipe Replacement on SR 2644 (Appian Way) Stream UT
to Buffalo Creek (WS- III)
Water Quality Criteria
Yes No
Stream Crossing Blue Line On USGS ., r-
ORW r W
WSI F r
WS II,III OR N, Crossing Within 0 5mi of W S Critical Area r r
Roadway Criteria
Route Designation-
Additional Site Information
Yes No
Arterial Urban r 9-
Arterial Rural 1` tv—
Yes No
Is a Hazardous Spill Basin Required? F
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997)