2012010 Ver 1_Application_20120724

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STATE OF NORTH CAROLINA
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DEPARTMENT OF TRANSPORTATION �q�
BEVERLY EAVES PERDUE EUGENE A CONTI IR
GOVERNOR SECRETARY
July 18 2012
Ms Liz Hair
Asheville Regulatory Field Office 1204 10
US Army Corps of Engineers
151 Patton Avenue Room 208
Asheville North Carolina 28801 5006
SUBJECT Pipe Replacement on SR 1112 (Bethany Road) Gaston County
Dear Ms Hair
The North Carolina Department of Transportation requests authorization to replace a structurally
deficient pipe on SR 1112 (Bethany Road) in Gaston County NCDOT proposes to replace a 50
foot long, 60" CW with a 60 -foot long, 72" CMP There is a sharp meander immediately
upstream of the existing pipe/headwall To prevent erosion aroumd the headwall of the structure
NCDOT proposes to realignment of the upstream channel to better align the stream and new
pipe Twenty six feet of old channel will be filled and —21 feet of new channel will be
constructed The new channel will be stabilized with coir fiber matting and streambed material
from the old channel will be salvaged and reused in the constructed channel Five feet of riprap
will be used at the pipe inlet and outlet for structure stabilization The stream bed immediately
upstream of the existing pipe (located in the sharp meander) is scoured therefore the invert of
the proposed pipe will be placed at the surveyed elevation of the undisturbed section of stream
channel noted as Matchline on the attached profile sketch Also as shown on the attached
profile sketch a shallow scourhole exists downstream of the pipe Class II Riprap will be used
if necessary to step down the flow to the existing streambed 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 protect Temporary cofferdams /bypass pumping will
be used to divert the stream around the construction site as needed Any areas affected by
temporary cofferdam system will be restored to pre project conditions
The total scope of the work will result in 25 feet of permanent impacts to an unnamed tributary to
South Crowders Creek which is classified as a Class C waters by the Division of Water Quality
The project area is not within '/z mile of a critical watershed area nor is SR 1112 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
Post Office Box 47 Shelby North Carolina 28151 0047

SR 1112 Bethany Road
Page 2
July 18 2012
This office has conducted a GIS and field survey for threatened and endangered species in the
vicinity of the project which include the bog turtle (Clemmys muhlenbergu) and
Schwemitiz s sunflower (Helianthus schweznitzii)
Natural Heritage Program records document the nearest bog turtle location approximately
9 miles northwest of the proposed project area Bog turtles are typically found in bogs
marshes, and wet pastures The area is maintained residential yards There is no
potential habitat within the proposed project area T /SA species are not subject to Section
7 consultation however no habitat exists in the proposed project area and impact on this
species is anticipated Natural Heritage Program records document the nearest
Schweimtz s sunflower location approximately 10 miles east of the proposed project area
The sunflower is usually found in upland open areas protected from shade or excessive
competition The area is mostly wooded and no little potential habitat is evident within
the proposed project area No impact on this 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 150464 55120005 12 203611 3300
• 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 David Wainwright, Division of Water Quality Transportation Permitting Unit
Alan Johnson Division of Water Quality Mooresville Regional Office

W AtERQG
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
lb
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
1 d
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
le
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
N No
2
Project Information
2a
Name of project
SR 1112 (Bethany Road)
2b
County
Gaston
2c
Nearest municipality / town
Gastonia
2d
Subdivision name
2e
NCDOT only T I P or state
project no
12B 203611
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 18813 Longitude 81 26008
(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 South Crowders Creek
proposed project
2b Water Quality Classification of nearest receiving water
Class C
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
Structurally deficient 50 60 CMP on paved road Surrounding landuse is mostly 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 a defiecient roadway 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 50 foot long 60 CMP with a 60 foot long 72 CMP There is a sharp meander
immediately upstream of the existing pipe /headwall To prevent erosion arouind the headwall of the structure NCDOT
proposes to realignment of the upstream channel to better align the stream and new pipe Twenty six feet of old channel
will be filled and —21 feet of new channel will be constructed The new channel will be stabilized with coir fiber matting
and streambed material from the old channel will be salvaged and reused in the constructed channel Five feet of nprap
will be used at the pipe inlet and outlet for structure stabilization The stream bed immediately upstream of the existing
pipe (located in the sharp meander) is scoured therefore the invert of the proposed pipe will be placed at the surveyed
elevation of the undisturbed section of stream channel (noted as Matchline on the attached profile sketch) As indicated on
the attached profile sketch a shallow scourhole also exists downstream of the pipe Riprap (Class II) will be used if
necessary to step down the flow to the existing streambed 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
Page 3 of 11
PCN Form — Version 1 3 December 10 2008 Version

5 Project History
5a Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes ® No ❑ Unknown
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 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 South
® PER
® Corps
10
length
Crowders Creek
❑ INT
® DWQ
S2 ®P ❑ T
Riprap for
structure
UT to South
® PER
® Corps
10
stabilization
Crowders Creek
E:1 INT
®DWQ
Total stream
S3 ®P ❑ T
channel lost due
Ut to South
® PER
® Corps
5
to minor stream
Crowders Creek
❑ INT
® DWQ
relocation
S4 ❑ P ®T
Cofferdam bypass
❑ PER
❑ Corps
pumping
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h Total stream and tributary impacts
25
31 Comments Permanent Impacts 26 feet of stream channel lost 21 feet of new channel constructed following natural
channel design principles
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
Temp ora 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 T 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)
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 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
Temoorary (T) impact
B1 ❑P ❑T
B2 ❑P ❑T
B3 ❑P ❑T
61 Comments
❑ Neuse ❑ Tar Pamlico ❑ Other
❑ Catawba ❑ Randleman
6e I 6f I 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 existing scour and site conditions it is proposed that the new pipe to be placed on grade rather than buried per
regulation to prevent stream destabilization
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
New channel construction to be stabilized with coir fiber matting and filled with salvaged streambed material from the old
channel that is to be backfilled
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
project?
❑ 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 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
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
1 a
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?
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 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
❑ 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
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 9 of 11
PCN Form — Version 1 3 December 10 2008 Version

F Supplementary Information
1 Environmental Documentation (DWQ Requirement)
la Does the project involve an expenditure of public (federal /state /local) funds or the
® Yes ❑ 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 ® No
or Riparian Buffer Rules (15A NCAC 213 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 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?
F1 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 3710351100J
Applicant/Agents Printed Name
Date
Appllcant/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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Date 7/17/2012 Caption Pipe Replacement SR 1112 (Bethany Road) UT to South
Scale 1 inch equals 1000 feet Crowders Crk Class C Waters Catawba River Basin
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Pipe Replacement
SR 1112, Bethany Road
Gaston County
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NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division 12 County Cleveland Project ID 12B 036011
River Basin Catawba Bridge No NA
Route Pipe Replacement on SR 1112 (Bethany Road) Stream UT
to South Crowders Creek (Class C)
Water Quality Criteria
x T l T
Stream Crossing Blue Line On USGS r we
ORW r
WSI
WS II,III OR IV, Crossing Within 0 5mi of W S Critical Area
Roadway Criteria
Route Designation-
Additional Site Information
Yes No
Arterial Urban r W/
Arterial Rural l— W
Is a Hazardous Spill Basin Required?
Yes No
r r
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997)