20210581 Ver 2_ePCN Application_20210723

DWR
Dlrlslon of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1, 2021 Ver4.1
Initial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
r Yes r No
Change only if needed.
BIMS # Assigned
20210581
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Alan Johnson:eads\adjohnson1
'Information for Initial Review
la. Name of project:
COURTESY COPY M-209 E)posure Repair
1a. Who is the Primary Contact?*
Robert Schwartz, P.E.
1b. Primary Contact Email:*
robert. schwa [e-mail]
Date Submitted
7/23/2021
Nearest Body of Water
South Fork Catawba River
Basin
Catawba
Water Classification
WS-V
Site Coordinates
Latitude: Longitude:
35.263278-81.060031
A. Processing Information
County (or Counties) where the project is located:
Gaston
Is this a NCDMS Project
r Yes r No
Is this project a public transportation project?*
r Yes r No
Pre -Filing Meeting Information
Version#*
2
Reviewing Office*
Mooresville Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
Is this a courtesy copy notification?*
r Yes r No

ID# Version
Pre -fling Meeting or Request Date
Attach documentation of Pre -Filing Meeting Request here:
dick the upload button or drag and drop files here to attach document
File type rust be FCF
1a. Type(s) of approval sought from the Corps:
W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r 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?
fJ 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: 03 - Maintenance
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r Non-404 Jurisdictional General Permit r Riparian Buffer Authorization
r Individual 401 Water Quality Certification
le. Is this notification solelyfor the record because written approval is not required?
For the record onlyfor DWR401 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
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?
rJ Owner r 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:
Dominion Energy North Carolina
2b. Deed book and page no.:
2c.Contact Person
2d.Address

Street Address
220 Operation Way
Address tine 2
City
Cayce
Postal / Zip Code
29033-3701
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
,bey Lawler
4b. Business Name:
S&ME
4c.Address
Street Address
2016 Ayrsley Town Boulevard, Suite 2-A
Address tine 2
city
Charlotte
Postal / Zip Code
28273
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
State / Province / Rion
South Carolina
Country
USA
2f. Fax Number:
Slate / Rmince / Region
North Carolina
Country
USA
4e. Fax Number:
C. Project Information and Prior Project History U
1. Project Information
1b. Subdivision name:
ff appropnate)
1c. Nearest municipality/ town:
Belmont
Project Identification
2a. Property Identification Number:
NA - DENC Easement
2c. Project Address
Street Address
South side of 1-85
Address tine 2
City
Belmont
Postal / Zip Code
28012
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
South Fork Catawba River
3b. Water Resources Classification of nearest receiving water:*
WS-V
3c. What river basin(s) is your project located in?*
Catawba
2b. Property size:
2.5 acres in LOD
Slate / Province / Ibgion
NC
Country
Gaston
3d. Please provide the 12-digit HUC in which the project is located.
030501020605

4. Project Description and History
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:*
The project area consists of a portion of Dominion Energy North Carolina's (DENC's) 50-foot wide M-209 natural gas pipeline easement. The existing easement is abutted on either side
by woodlands and is located on the south side of 1-85 in Belmont, Gaston County, North Carolina. A portion of the existing gas line has become exposed in an unnamed tributary to the
South Fork Catawba River. The maintained easement is abutted by forested areas on either side. The vicinity consists of forested areas to the east and west of the corridor; scattered
residential development to the east and west; with Interstate 85 (1-85) bordering to the north and some industries to the south.
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
4f. List the total estimated acreage of all existing wetlands on the property:
0
4g. List the total estimated linear feet of all existing streams on the property:
50
4h. Explain the purpose of the proposed project:*
To replace an exposed segment of the M209 natural gas transmission pipeline with a new segment to be installed at a lower depth.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
DENC is planning to replace a segment of their pipeline that has become exposed in a streambed. The exposed pipe will be removed and a new pipe installed at a lower depth beneath
the streambed. Portions of the streambank that are temporarily affected during the work will be stabilized and restored upon completion, per the attached plans.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No r 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): Rebeckah Sims and Kylie Wallace
Agency/Consultant Company: S&ME
Other:
6. Future Project Plans
6a. Is this a phased project?*
r 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 project or related activity?
Not applicable.
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
r Wetlands W Streams -tributaries r Buffers
r Open Waters r Pond Construction
3. Stream Impacts
3a. Reason for impact (?) 3b.lmpact type * 3c. Type of impact* 3d. S. name * 3e. Stream Type * �3f. Type of 3g. S. width* �3h. Impact
(?) Jurisdiction* length*
e T
i1
Replace exposed pipem ora Excavation S-1 ::1ff:::]
Both 20 50 P rY Average(feet) (linearfcet)
31. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts: 3i. Total temporary stream impacts:
0 50
31. Total stream and ditch impacts:
50

3j. Comments:
Stream will be temporarily impacted during removal of exposed pipe, installation of new pipe and restoration of affected banks. Work will be conducted
"in -the -dry" and in accordance will all applicale conditions of NIWP-3 and the associated WQC.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The project has been designed to incorporate appropriate erosion and sediment control practices outlined in the most recent version of the "North
Carolina Erosion and Sedimentation Control Planning and Design Manual" and approved by the North Carolina Department of Environment and
Natural Resources (NCDENR) prior to construction.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
To minimize impacts to Waters of the U.S., DENC has proposed to limit the space within which the work will be conducted to the existing easement.
Additionally, construction equipment operating near the stream will be limited to that necessary for pipe replacement and stabilization/restoration
activities.
As proposed, the project will comply with applicable conditions of the USACE NWP No. 12 and NCDWR WQC GC No. 4133. Following the repair work,
the temporarily -affected banks of Stream 1 will be restored in accordance with the accompanying construction documents. We anticipate that
construction of the lowwater crossing at both Stream 1 and Stream 2 Will minimize future impact from mowing equipment when access to the high
ground portion of the easement is required.
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
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Because the project will not result in permanent stream impacts that exceed 150 linear feet of stream or any wetland impacts, compensatory mitigation should not be required.
F. Stormwater Management and Diffuse Flow Plan (required by DWR) u
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes r No
If no, explain why:
Buffer protections apply only to the mainstem of the Catawba River and inline lakes, therefore riparian buffer protections do not apply to this stream.
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:
Project will not result in additional impervious surface.
G. Supplementary Information
1. Environmental Documentation
1a. 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 (15A NCAC 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
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
This project is within an existing utility easement and involves repair efforts. This will not result in cumulative impacts or the generation of additional
development.

4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR forth is project?*
rYes r Nor WA
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 r 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.
Asheville
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
f Unknown
5i. 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, NCNHP and field review. Project should not affect federally protected species.
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 Mapper.
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 SHPO HPOWEB2.0. Project should not impact historic or archeological resources.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-yearfloodplain?*
r Yes r- No
8b. If yes, explain how project meets FEMA requirements:
The project will comply with local floodplain ordinances and approvals.
8c. What source(s) did you use to make the floodplain determination?*
FEMA Floodplain Mapper
Miscellaneous
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one
file when possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred.
Click the upload button or drag and drop files here to attach docurrent
Agent Authorization Form.pdf 191.05KB
M-209 Photo Log.pdf 309.9KB
Figures and Constuction Drawings.pdf 23.66MB
File rrust be P0F or ME
Comments
All project impacts are temporary. As the project does not require pre -construction written approval, this PCN is being submitted as a courtesy.

Signature
u
® By checking the box and signing below, I certify that:
• 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:
,bey Lawler
Signature
.ia�y t�wr�
Date
7/23/2021

AGENT AUTHORIZATION FORM
Date: 06/02/20
Nro ect intormation
S&ME Project Name: Dominion Energy North Carolina (DENC) Projects
Type of Project: Natural Gas Transmission/Distribution Construction/Maintenance Projects
Location: DENC North Carolina Service Territory
Nroperty Uwner/Kep intormation
Owner Name: Dominion Energy Southeast Services, Corporate Environmental
Mailing Address: 220 Operations Way, MC C221
Cayce, SC 29033
Telephone No. 803.217.7112
Contact: Robert Schwartz, PE
Aaent Intormation
Business Name:
Street Address:
City, State, Zip:
Telephone No.
Contact:
S&ME, Inc.
9751 Southern Pine Blvd
Charlotte, NC 28273
704.523.4726
Joey Lawler, PWS
Authorization: I, _ A. Robert Schwartz , hereby authorize S&ME, Inc. to
submit information to and coordinate with the US Army Corps of Engineers
(USACE) and/or the NC Division of Environmental Quality (NCDEQ) and other
relevant Federal/State/Local agencies pursuant to obtaining necessary
environmental permits for various DENC natural gas -related projects. If
applicable, this also authorizes the USACE/NCDEQ to access DENC
existing/proposed easements for the purposes of conducting site
assessment/confirming the accuracy of delineated boundaries.
Signature: �=
S&ME, INC. / 9751 Southern Pine Blvd / p 704.523.4726 f 704.525.3953 / www.smeinc.com

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GIs BASE LAYERS WERE OBTAINED FROM THE ESRI STREETMAP VIEWER. THIS MAP IS FOR
INFORMATIONAL PURPOSES ONLY. ALL FEATURE LOCATIONS DISPLAYED AREr 1
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DATE:
III E 4-2-2021 1
M-209 EXPOSURE PROJECT NUMBER
BELMONT, NORTH CAROLINA 211496

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DATE:
III E M-209 EXPOSURE 4-2TNUM 2
PROJECT NUMBER
BELMONT, NORTH CAROLINA 211496

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DATE:
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PROJECT NUMBER
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SITE PHOTOGRAPHS
* DENC M-209 Streambank Exposure
Belmont, NC
S&ME Project No. 211496
s
PHOTOGRAPH1
VIEWING DIRECTION: Northeast
DESCRIPTION/COMMENT: View of
maintained ROW at entrance to
assessment area.
PHOTOGRAPH
VIEWING DIRECTION: North
DESCRIPTION/COMMENT: View of
maintained ROW facing north.

'A
PHOTOGRAPH
VIEWING DIRECTION: Northeast
DESCRIPTION/COMMENT: View of
maintained ROW facing northeast.
Non -JD drainage pattern in
viewport.
PHOTOGRAPH 4
VIEWING DIRECTION: North
DESCRIPTION/COMMENT: View of
end off assessment area facing
north. SA-1 within frame. M-209
exposure can be seen at the
waterfall line. M-209 pipeline is
encased in concrete curtain.
SITE PHOTOGRAPHS
DENC M-209 Streambank Exposure
Belmont, NC
S&ME Project No. 211496

SITE PHOTOGRAPHS
* DENC M-209 Streambank Exposure
Belmont, NC
S&ME Project No. 211496
s
PHOTOGRAPH5
VIEWING DIRECTION: East
DESCRIPTION/COMMENT: View of
SA-1 facing upstream toward the
east.