20140212 Ver 1_401 Application_20140314

LETTER OF TRANSMITTAL 2 0 1 4 0 2 1 2
S&ME, Inc.
9751 Southern Pine Blvd.
Charlotte, NC 28273
704.523.4726
704.525 -3953 fax
To: NC Division of Water Resources
401 and Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
FILE COPY
Date: March 3, 2014
Job No. 4335 -14 -033
Mill Creek Low Water
Ford Crossing
Attn Ms Karen Higgins
We Are Sending You ® Attached ❑ Under separate cover via
following items
❑ Shop drawings ❑ Contract ❑ Plans
❑ Copy of letter ❑ Report
❑ Samples ❑ Specifications
p��
the
Copies
Date
No
Description
5
2/28/14
1
Pre - construction Notification NWP No 12/WQC No 3884
1
3/3/14
2
CD of PCN
1
2/24/14
3
Check #022696 for $240 00
These Are Transmitted As Checked Below
® For approval ® For your use
❑ As requested ❑ For Review
❑ For Bids Due _ /_ /_ ❑ Prints Returned After Loan To Us
@IN owpm
D
MAR 0 4 2014
MR - _ TEP, ,YjALITY
Remarks Enclosed are 5 copies of PCN, 1 CD and 1 check If you have any
questions, please call Joey Lawler at 704 - 523 -4726 Thank you
Signed
Gloria A Keiffer, Administrative Assistant

LETTER OF TRANSMITTAL
S&ME, Inc.
9751 Southern Pine Blvd.
Charlotte, NC 28273
704.523.4726
704.525 -3953 fax
To: NC Division of Water Resources
401 and Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
1
MAR 0 4 ZU1�
D
wA�� t�GaZl Y
.d— amnch
Date: March 3, 2014
Job No. 4335 -14 -033
Mill Creek Low Water
Ford Crossing
Attn Ms Karen Higgins
We Are Sending You ® Attached ❑ Under separate cover via
following items
❑ Shop drawings ❑ Contract ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Report
the
Copies
Date
No
Description
5
2/28/14
1
Pre - construction Notification NWP No 12MQC No 3884
1
3/3/14
2
CD of PCN
1
2/24/14
3
Check #022696 for $240 00
These Are Transmitted As Checked Below
®
For approval
®
For your use
❑
As requested
❑
For Review
❑
For Bids Due _/ /_
❑
Prints Returned After Loan To Us
Remarks Enclosed are 5 copies of PCN, 1 CD and 1 check If you have any
questions, please call Joey Lawler at 704 - 523 -4726 Thank you
Signed
Gloria A
istrative Assistant

February 25, 2014
U.S. Army Corps of Engineers
Raleigh Regulatory Field Office
3331 Heritage Trade Drive
Raleigh, North Carolina 27587
Attention: Mr. John Thomas
N.C. Division of Water Resources
401 and Buffer Permitting Unit
1650 Mail Service Center
Raleigh, North Carolina 27699 -1650
Attention: Ms. Karen Higgins
Reference: Pre - construction Notification: NWP No. 12/WQC No. 3884
Mill Creek Low Water Ford Crossing
Winston - Salem, North Carolina
S &ME Project No. 4335 -14 -033
Dear Mr. Thomas and Ms. Higgins:
On behalf of Piedmont Natural Gas (PNG), S &ME, Inc. (S &ME) is submitting this
application for construction of a low water ford -type equipment crossing at a single
location along Mill Creek. The proposed crossing will be located within PNG's existing
natural gas pipeline right -of -way (ROW). The site is located east of Shattalon Drive,
north of Petree Road and south of Ryan Way in the City of Winston Salem, Forsyth
County, North Carolina (36.132269° N, - 80.335411° W).
In support of this application, please find enclosed the following:
• Figures: Site Vicinity Map (Figure 1), USGS Topographic Map (Figure 2) and
2010 Aerial Photograph (Figure 3)
• Appendix I: Completed Pre - construction Notification (PCN) and Agent
Authorization
• Appendix II: Site Photographs
• Appendix III: Request for Preliminary JD and Supporting Information
• Appendix IV: Construction Detail Exhibit
The crossing will not involve importation of fill material into the floodplain or any loss of
waters of the U.S., and is not located in an area subject to Randleman Reservoir or Jordan
Lake watershed riparian buffer rules. Accordingly, the work can be performed under
Nationwide Permit (NWP) No. 12 (Utility Line Activities) from the U.S. Army Corps
S &ME, INC. / 9751 Southern Pine Blvd / Charlotte, NC 28273 / p 704.523.4726 f 704.525.3953 / www.smeinc.com

Pre - construction Notification: NWP No. 12/WQC No. 3884 S &ME Project No. 4335 -14 -033
Mill Creek Low Water Ford Crossing -Winston-Salem, N.C. February 25, 2014
(USACE) of Engineers and General Water Quality Certification (GC) 3884 from the
North Carolina Division of Water Resources ( NCDWR). The project will comply with
all applicable conditions of the NWP and GC, but requires written concurrence from
NCDWR because the stream impacts will be considered permanent.
BACKGROUND INFORMATION
The general project area is located in the Piedmont Geographic Province, in the Upper
Pee -Dee River Basin (HUC 03040101). The project site consists of PNG's existing 50-
foot wide gasline ROW immediately adjacent to the run of Mill Creek ( NCDWR Index
No. 12 -94 -4, Class C), approximately one river -mile upstream of its confluence with
Muddy Creek. The site is located within the AE Zone of Mill Creek's floodplain, as
indicated by FIRM Panel No. 3710680600J. The location of the project area is depicted
on the Site Vicinity Map (Figure 1), the applicable section of the Rural Hall, N.0 (1994)
and Winston -Salem West, N.C. (1994) USGS Topographic Maps (Figure 2), and a 2010
Aerial Photograph (Figure 3).
The project area is largely composed of maintained utility line ROW, and is abutted by
woodland and open field. The larger project area consists primarily of undeveloped
woodland, open field and residential neighborhoods. Vegetation within the existing ROW
included various grasses (Festuca spp.), dog fennel (Eupatorium capillifolium), poke
(Phytolacca americana), broomstraw (Andropogon virginicus), switchgrass (Panicum
virgatum), and goldenrod (Solidago sp.). Tree and shrub species within wooded areas
adjacent to the project site included river birch (Betula nigra), ironwood (Carpinus
carohniana), green ash (Fraxinus pennsylvania), sweetgum (Liquidambar styracifZua)
and Chinese privet (Ligustrum sinense). Understory vegetation was dominated by poison
ivy (Toxicodendron radicans) and giant cane (Arundinaria gigantea). Wetlands were no
identified within the project area. Photographs of the Mill Creek crossing location are
included in Appendix II, and a Request for Preliminary Jurisdictional Determination
Form is included in Appendix III.
Construction of the low water ford crossing is necessary to accommodate passage of
heavy equipment that must access an otherwise inaccessible segment of their existing
Winston -Salem North Loop natural gasline ROW. The area that PNG must access is
isolated by two segments of Mill Creek that cross the ROW at separate locations.
Currently, maintenance equipment must travel through a series of adjacent properties and
a residential neighborhood with which there are no formal access agreements in place.
PNG has been unable to negotiate a formal, permanent access agreement with the
adjacent property owners. Further, while the informal access route is capable of
accommodating the light mowing equipment PNG uses to perform their routine yearly
maintenance, it is not capable of supporting heavier timbering and side - trimming
equipment, which will be required to remove some trees that have grown into PNG's
ROW within the landlocked area. Construction of the low water ford will allow PNG's
equipment to access the area in the future by remaining entirely within their existing
ROW, and eliminate the need to travel through a residential area.
2

Pre - construction Notification: NWP No. 12/WQC No. 3884 S &ME Project No. 4335 -14 -033
Mill Creek Low Water Ford Crossing -Winston-Salem, N.C. February 25, 2014
PROPOSED PROJECT IMPACTS
The proposed project involves construction of an approximately 12 -14 foot wide, low -
water access ford at Mill Creek. To accommodate equipment passage down to the level
of the streambed, the existing channel cross - section will be cut from their existing, near -
vertical slope to approximately 10:1. The crossing will then be stabilized by employing a
flexible, articulated concrete block mattress as a subgrade, overlain with natural substrate
and appropriately -sized rock material to provide erosion control and accommodate the
necessary vehicle load capacity. The aggregate will be extended up the bed of the
approach for a suitable distance, then the remainder seeded and mulched. Side slopes of
the approaches will be graded at 2:1 and tie into existing ground surface elevation. The
side slopes will then be seeded and matted to prevent erosion. The project has been
designed such that the finished grade of the streambed should match that of its original
grade, preventing a "damming" effect.
It is anticipated that no more than 12 linear feet (If) of streambed will be permanently
affected by construction of the ford. The work will be constructed in the dry through use
of a dam - and -pump system, or by temporary construction of a phased coffer dam system
that will allow clean water to bypass the work area. Placement of the coffer dams may
temporary impact up to 25 additional feet of stream channel.
A plan view and cross - section of the proposed low water ford crossing is included in
Appendix IV.
PROTECTED SPECIES AND CULTURAL RESOURCES
Protected Species
S &ME's consideration of potential protected species habitat began with a review of
existing records obtained from federal and state sources. The U.S. Fish & Wildlife
Service (USFWS) list of federally protected species (updated September 22, 2010) was
consulted for a listing of protected species documented within Forsyth County, North
Carolina. This review identified three species carrying threatened or endangered
designations. Listed flora and fauna and their federal rank and county status are
identified in Table 1. Explanations of rankings are included at the end of the table.
Table 1: Federally Protected Flora and Fauna Summary
Species
Federal Rank"
County Status
Glyptemys muhlenbergii
T
Current
Bog Turtle
Cardamine micranthera
E
Historic
Small - anthered Bittercress
Picoides borealis
E
Historic
Red - cockaded Woodpecker
E = Endangered; T = Threatened
As part of the protected species review, S &ME also reviewed the North Carolina Natural
Heritage Program (NCNHP) Geographic Information Systems (GIS) files of Element
Occurrence (EO) and Natural Heritage Areas available from NC OneMap. This review

Pre - construction Notification: NWP No. 12/WQC No. 3884 S &ME Project No. 4335 -14 -033
Mill Creek Low Water Ford Crossing -Winston-Salem, N.C. February 25, 2014
found no extant EOs of protected species on record within a two -mile radius of the
project area.
Brief descriptions of the species identified in Table 1 taken from USFWS descriptions are
provided below:
Bog Turtle
Status. Federally Listed Threatened
Biological Determination. May Affect, Unlikely to Adversely Affect
The bog turtle is a small semi - aquatic turtle, with a distinctive patch on each side of the
head which can vary from yellow, orange or red depending on the population. The
carapace is 3 to 4.5 inches in length (7.6 to 11.4 cm). The carapace is not strongly keeled
and has yellowish red scutes.
In old adults, the carapace will be worn smooth, presumably from burrowing in soil,
while juveniles possess a rougher textured carapace. The plastron is hingless, dark brown
to black with yellowish or brown mottling. The skin is gray to brown streaked with red or
yellow markings.
The bog turtle is a habitat specialist and is most commonly found in bogs, swamps, and
wet meadows which have slow and shallow streams with deep soft muck soils and
tussock - forming herbaceous vegetation. This turtle often burrows in the mud and is
considered an elusive species that may be difficult to find. The southern population of
the bog turtle ranges from southern Virginia to northern Georgia.
Although potentially - suitable habitat for bog turtle likely exists in the larger vicinity, the
project area does not contain wetlands or similarly - suitable habitat. Accordingly, work
associated with the construction of the low water ford crossing is unlikely to adversely
affect this species.
Small - anthered Bittercress
Status. Federally Listed Endangered
Biological Determination. May Affect, Unlikely to Adversely Affect
This perennial herb is a member of the mustard or cress family. It has an erect and
slender stalk, with fibrous roots and typically one, but occasionally several, simple or
branched stem(s) growing 20 to 40 centimeters tall. Basal leaves have one or two pairs
of small lateral lobes, while stem leaves are alternate and mostly unlobed. The plant
flowers and fruits from April to May. The flowers consist of four white petals, six
stamens, and small, rounded anthers. The fruit contains brown seeds that are
approximately one millimeter long. It is distinguished from its common relative,
Cardamine rotundifolia, by its smaller flowers and fruits that are half as long as those of
C. rotundifolia.
Small - anthered bittercress occurs on small streambank seeps, adjacent sandbars, and
stream edges in Dan River drainage of the North Carolina and Virginia piedmont. Most
of the remaining populations are extremely small (some containing less than half a dozen
plants). Many are in close proximity to fields and pastures, where they are vulnerable to
herbicides, erosion, and siltation.
4

Pre - construction Notification: NWP No. 12/WQC No. 3884 S &ME Project No. 4335 -14 -033
Mill Creek Low Water Ford Crossing -Winston-Salem, N.C. February 25, 2014
Although potentially - suitable habitat for small - anthered bittercress exists in the project
area, this specie has not been documented within the county within 20 years, and is listed
as an "historic" occurrence. Accordingly, work associated with the construction of the
low water ford crossing is unlikely to adversely affect this species.
It should be noted that property on the west side of the proposed crossing (Camerille
Farms) is protected by a conservation easement managed by Piedmont Lands
Conservancy, and was subject to an initial biologic inventory, as well as annual
stewardship visits by conservancy biologists. PNG representatives notified Piedmont
Lands Conservancy of the proposed crossing, and will continue to coordinate with area
landowners as necessary.
Red - cockaded Woodpecker
Status. Federally Listed Endangered
Biological Determination. No Effect
This species is listed as a historic occurrence within Forsyth County. Red - cockaded
woodpecker measure approximately seven inches long and have black and white
horizontal stripes on its back. The cheeks and underparts are white and the sides are
streaked in black. The cap and stripe on the throat and neck of the bird are black. Male
individuals of the species have a small red spot on each side of the black cap and display
a red crown patch after the first post - fledgling molt. The woodpecker's diet consists
primarily of insects.
Red - cockaded woodpecker's range is closely linked to the distribution of mature stands
of southern pines. Longleaf and loblolly pines that are 60 years old or greater are most
commonly selected for nesting and roosting trees. The woodpecker excavates nest and
roost cavities in trees that are stressed, and often are infected with red -heart rot fungus.
Preferred nesting sites generally include relatively open, park -like, mature pine stands
with a suppressed mid -story layer. Suppression of the mid -story by fire or mechanical
means in mature pine stands promotes colonization by the red - cockaded woodpecker.
Foraging habitat is frequently limited to pine or pine- hardwood stands that are 30 years
old or greater with a preference for pine trees with a diameter of 10 inches or larger.
Dense hardwood mid -story hampers foraging by red - cockaded woodpecker and increases
the occurrence of cavity competitors. The USFWS indicates that the maximum foraging
radius from a colony site for red - cockaded woodpecker's is typically one -half mile or
less.
No stands of pine that were mature enough to contain suitable nesting habitat for the red -
cockaded woodpecker were observed. No tree removal will occur as a result of the
project. Therefore, it is not likely that the red - cockaded woodpecker or potential habitat
will be disturbed as a result of this project.
Cultural Resources
Review of the State Historic Preservation Office (SHPO) GIS Web Service indicated that
there were no properties currently listed or determined eligible for listing in the National
Register of Historic Places within the vicinity of the project site that are likely to be
affected.

Pre - construction Notification: NWP No. 12/WQC No. 3884 S &ME Project No. 4335 -14 -033
Mill Creek Low Water Ford Crossing -Winston-Salem, N.C. February 25, 2014
AVOIDANCE AND MINIMIZATION
Impacts have been avoided and minimized to the extent practicable and have been limited
to what is necessary to construct a crossing of the minimum width necessary to
adequately accommodate vehicular access to otherwise inaccessible high ground areas
requiring future maintenance. More invasive crossing methods, such as culvert
placement or permanent bridge construction, were evaluated but later eliminated from
consideration. Construction of the low water ford crossing will serve the dual purpose of
providing vehicular access and bank stabilization, while minimally altering the existing
character of the surrounding area.
To prevent sedimentation of downstream portions of Mill Creek, construction will be
conducted in the dry by employing either a dam - and -pump or temporary diversion system
to isolate the work area. Temporary erosion and sediment control measures placed in
waters will be removed and the original grade restored upon completion of the project.
REGULATORY CONSIDERATIONS
To comply with applicable FEMA approved local floodplain management requirements,
a Floodplain Development Permit, along with flood study modeling (existing and
proposed conditions) and a "No Rise" Certification, must be obtained from the City of
Winston Salem. S &ME has notified the City's Floodplain Manager of the proposed
project and is currently conducting the appropriate modeling. No work will be conducted
until the Floodplain Development Permit has been issued.
Following construction, disturbed areas within the vicinity of the work site will be
restored to original grade and elevation, seeded and stabilized. Appropriate erosion and
sediment control practices will be implemented to meet water quality turbidity standards.
Best Management Practices employed for the project will be in compliance with the most
recent version of the "North Carolina Sediment and Erosion Control Planning and Design
Manual," and the local governing authority.
RESTORATION OF AFFECTED AREA
Temporarily- affected areas associated with construction of the low water ford crossing
will be restored to their original contours and conditions to the degree practicable upon
project completion. Disturbed streambanks associated with the crossing approaches and
temporary work areas will be permanently stabilized with a native vegetative cover and
coir matting. On the streambanks, the native riparian seed mix specified in Table 2 below
shall be utilized.
P

Pre - construction Notification: NWP No. 12/WQC No. 3884 S &ME Project No. 4335 -14 -033
Mill Creek Low Water Ford Crossing -Winston-Salem, N.C. February 25, 2014
Table 2: Riparian Seed Mix*
Species
Common Name
Percentage of Mix
Elymus virginicus
Virginia wild rye
15
Panicum virgatum
Switchgrass
15
Agrostis stolinifera
Creeping bentgrass
10
Rudbeckia hirta, NC ecotype
Black -eyed Susan
10
Coreopsis lanceolata
Lance leaf tickseed
10
Panicum clandestinum
Deer tongue
10
Andropogon gerardii
Big bluestem
05
Juncus effusus
Soft rush
05
Echinochloa muricata
Awned barnyard grass
05
Schizachyrium scoparium
Little bluestem
05
Sorghastrum nutans
Indian grass
05
Tripsacum dactyloides
Gamma grass
05
competitor.
Lolium
100
Riparian Seed Mix to be applied to all disturbed streambanks, extending five feet landward following construction.
Recommended application rate: 20 -25 lbs. per acre
To provide quicker cover, the mix specified in Table 2 will be augmented with the
appropriate cover /companion species, as identified in Table 3.
Table 2: Cover /Companion Crops
Species
Common
Season
Mix
Notes:
Festuca
3 -5 Ibs /acre;
Weak competitor; does not
brevipila
Hard fescue
Fall, Winter
20%
interfere with native grasses.
Shade tolerant.
Festuca ovina
Sheep
Fall, Winter
3 -5 Ibs /acre;
fescue
20%
Secale cereale
Ceareal or
Early Spring
30 Ibs /acre
Grows 3 -4' tall, but not a strong a
Winter rye
or Fall
competitor.
Lolium
Perennial
Spring,
20 -50%
Shorter rye; lasts about 2 years,
perenne
rye
Summer
then dies out.
Foxtail or
Spring,
Good germination; dies off with
Setaria italica
German
Summer
o
20-50%
frost; does not tolerate mowing.
Millet
Use of annual rye (Lolium multiflorum) is not recommended, as it competes with native
grasses for water and nutrients.
Material excavated to construct the crossing approaches will be uniformly spread over
highground portions of the ROW and seeded /mulched. Appropriate erosion and sediment
control practices will be implemented during and after construction, as appropriate.
MITIGATION
The proposed revision will not result in project -wide permanent impacts that exceed 150
If of stream channel, and there will be no wetland impacts. Accordingly, mitigation for
the project impacts should not be required.

Pre - construction Notification: NWP No. 12/WQC No. 3884 S &ME Project No. 4335 -14 -033
Mill Creek Low Water Ford Crossing -Winston-Salem, N.C. February 25, 2014
CLOSING
By copy of this correspondence and completed PCN, we are requesting your written
concurrence with this permit application. If you have questions or require additional
information, please feel free to contact us at 704.523.4726.
Sincerely,
S &ME
Darrin Peine, Q.E.P. Joey Lawler, P.W.S.
Natural Resources Scientist Project Manager
[e-mail] [e-mail]
Senior Reviewed by Julie Bennett - Hudel, P.G., LEED AP BD +C
Attachments

FIGURES

APPENDIX I:
COMPLETED PCN AND AGENT AUTHORIZATION

QaeWAr,R7
� r
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Page 1 of 12
PCN Form — Version 1.3 December 10, 2008 Version
Pre - Construction Notification PCN Form
A. Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: 12 or General Permit (GP) number:
1 c.
Has the NWP 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
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
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 In
below.
❑ Yes
® No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2.
Project Information
2a.
Name of project:
Mill Creek Low Water Ford Crossing
2b.
County:
Forsyth
2c.
Nearest municipality / town:
Winston -Salem
2d.
Subdivision name:
N/A
2e.
NCDOT only, T.I.P. or state
project no:
N/A
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Piedmont Natural Gas
3b.
Deed Book and Page No.
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
4720 Piedmont Row Drive
3e.
City, state, zip:
Charlotte N.C. 28210
3f.
Telephone no.:
704.572.7985
3g.
Fax no.:
3h.
Email address:
jim.kalish @piedmontng.com
Page 1 of 12
PCN Form — Version 1.3 December 10, 2008 Version

4.
Applicant Information (if different from owner)
4a.
Applicant is:
❑ Agent ® Other, specify: Utility Company
4b.
Name:
Jim Kalish
4c.
Business name
(if applicable):
Piedmont Natural Gas
4d.
Street address:
4720 Piedmont Row Drive
4e.
City, state, zip:
Charlotte N.C. 28210
4f.
Telephone no.:
704.572.7985
4g.
Fax no.:
704.731.4098
4h.
Email address:
jim.kalish @piedmontng.com
5.
Agent/Consultant Information (if applicable)
5a.
Name:
Joey Lawler, P.W.S.
5b.
Business name
(if applicable):
S &ME, Inc.
5c.
Street address:
9751 Southern Pine Boulevard
5d.
City, state, zip:
Charlotte, N.C. 28723
5e.
Telephone no.:
704.523.4726
5f.
Fax no.:
704.525.3853
5g.
Email address:
jlawler @smeinc.com
Page 2 of 12
PCN Form — Version 1.3 December 10, 2008 Version

B.
Project Information and Prior Project History
1.
Property Identification
1 a.
Property identification no. (tax PIN or parcel ID):
6806 -49- 4803.00 and 6806 -69- 5316.00
1 b.
Site coordinates (in decimal degrees):
Latitude: 36.13240 Longitude: - - 80.33524
(DD.DDDDDD) (- DD.DDDDDD)
1 c.
Property size:
< 0.2 acre acres
2.
Surface Waters
2a.
Name of nearest body of water (stream, river, etc.) to
Mill Creek
proposed project:
2b.
Water Quality Classification of nearest receiving water:
C
2c.
River basin:
Upper Pee -Dee
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:
The general project area is located in the Piedmont Geographic Province, in the Upper Pee -Dee River Basin (HUC
03040101). The project site consists of PNG's existing 50 -foot wide gasline ROW immediately adjacent to the run of Mill
Creek (NCDWR Index No. 12 -94 -4, Class C), approximately one river -mile upstream of its confluence with Muddy Creek.
The project area is largely composed of maintained utility line ROW, and is abutted by woodland and open field. The
larger project area consists primarily of undeveloped woodland, open field and residential neighborhoods.
3b.
List the total estimated acreage of all existing wetlands on the property:
Unknown - none are located within the project area
3c.
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
The run of Mill Creek crosses the existing 50' ROW in a roughly perpendicular manner.
3d.
Explain the purpose of the proposed project:
Construction of the low water ford crossing is necessary to accommodate passage of heavy equipment that must access
an otherwise inaccessible segment of their existing Winston -Salem North Loop natural gasline ROW. The area that PNG
must access is isolated by two segments of Mill Creek that cross the ROW at separate locations. Currently, maintenance
equipment must travel through a series of adjacent properties and a residential neighborhood with which there are no
formal access agreements in place. PNG has been unable to negotiate a formal, permanent access agreement with the
adjacent property owners. Further, while the informal access route is capable of accommodating the light mowing
equipment PNG uses to perform their routine yearly maintenance, it is not capable of supporting heavier timbering and
side - trimming equipment, which will be required to remove some trees that have grown into PNG's ROW within the
landlocked area. Construction of the low water ford will allow PNG's equipment to access the area in the future by
remaining entirely within their existing ROW, and eliminate the need to travel through a residential area.
3e.
Describe the overall project in detail, including the type of equipment to be used:
The proposed project involves construction of an approximately 12 -14 foot wide, low -water access ford at Mill Creek. To
accommodate equipment passage down to the level of the streambed, the existing channel cross - section will be cut from
their existing, near - vertical slope to approximately 10:1. The crossing will then be stabilized by employing a flexible,
articulated concrete block mattress as a subgrade, overlain with natural substrate and appropriately -sized rock material to
provide erosion control and accommodate the necessary vehicle load capacity. The aggregate will be extended up the
bed of the approach for a suitable distance, then the remainder seeded and mulched. Side slopes of the approaches will
be graded at 2:1 and tie into existing ground surface elevation. The side slopes will then be seeded and matted to
prevent erosion. The project has been designed such that the finished grade of the streambed should match that of its
original grade, preventing a "damming" effect.
It is anticipated that no more than 12 linear feet (If) of streambed will be permanently affected by construction of the ford.
The work will be constructed in the dry through use of a dam - and -pump system, or by temporary construction of a phased
coffer dam system that will allow clean water to bypass the work area. Placement of the coffer dams may temporary
impact up to 20 additional feet of stream channel. Industry - standrad earth- moving equipment will be used to perform the
work.
Page 3 of 12
PCN Form — Version 1.3 December 10, 2008 Version

4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
El Yes El No ®Unknown
project (including all prior phases) in the past?
Comments: Unknown
4b. If the Corps made the jurisdictional determination, what type
El Preliminary El Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency /Consultant Company: S &ME, Inc.
Name (if known):.
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
An S &ME Wetland Scientist visited the site on january 17, 2014 and assessed the project area for the presence of
wetlands. S &ME followed the procedures set forth in the 1987 US Army Corps of Engineers Wetlands Delineation
Manual (Eastern Mountains and Piedmont Regional Supplement Guide), and determined that wetlands were not present
within the poroject area.
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.
N/A
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6b. If yes, explain.
N/A
Page 4 of 12
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ® Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
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: No wetland impacts will occur.
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
Construction of
Mill Creek
® PER
® Corps
25
12
ford
❑ INT
® DWQ
S2 ❑ P ®T
Temporary coffer
Mill Creek
® PER
® Corps
25
25
dams /work area
❑ INT
® DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ 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
37
3i. Comments: Of the 37 If of streambed impacts, 25 If are temporary and 12 If are permanent.
Page 5 of 12
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: No open -water impacts will occur.
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.
5b.
5c.
5d.
5e.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
K Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
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.
❑ Neuse ❑ Tar - Pamlico ❑ Other:
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary (T)
impact
required?
B1 ❑P ❑T
F-1 Yes
❑ No
B2 ❑P ❑T
F-1 Yes
❑ No
B3 ❑P ❑T
F-1 Yes
❑ No
6h. Total buffer impacts
6i. Comments: No buffer imapcts will occur.
Page 6 of 12
PCN Form — Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Impacts have been avoided and minimized to the extent practicable and have been limited to what is necessary to construct a
crossing of the minimum width necessary to adequately accommodate vehicular access to otherwise inaccessible high ground
areas requiring future maintenance. More invasive crossing methods, such as culvert placement or permanent bridge
construction, were evaluated but later eliminated from consideration. Construction of the low water ford crossing will serve the
dual purpose of providing vehicular access and bank stabilization, while minimally altering the existing character of the
surrounding area.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
To prevent sedimentation of downstream portions of Mill Creek, construction will be conducted in the dry by employing either a
dam - and -pump or temporary diversion system to isolate the work area. Temporary erosion and sediment control measures
placed in waters will be removed and the original grade restored upon completion of the project.
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 mitigation 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: N/A
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
3c. Comments: N/A
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:
0 linear feet
4c. If using stream mitigation, stream temperature:
❑ warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only):
0 square feet
4e. Riparian wetland mitigation requested:
0 acres
4f. Non - riparian wetland mitigation requested:
0 acres
4g. Coastal (tidal) wetland mitigation requested:
0 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.
N/A
Page 7 of 12
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
❑ Yes ® No
buffer mitigation?
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.
6c.
6d.
6e.
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(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).
N/A
6h. Comments:
Page 8of12
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: N/A
2d.
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
N/A
❑ 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?
❑ 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 12
PCN Form — Version 1.3 December 10, 2008 Version

F.
Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1 a.
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: N/A
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):
N/A
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 not considered "growth- inducing" in that its purpose is only to probide maintenance access an existing
natural gas transmission ROW.
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.
The project will not generate waste water.
Page 10 of 12
PCN Form — Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ® No
impacts?
F-1 Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
S &ME's consideration of potential protected species habitat began with a review of existing records obtained from federal
and state sources. The U.S. Fish & Wildlife Service ( USFWS) list of federally protected species was consulted for a
listing of protected species documented within Forsyth County, North Carolina. This review identified three species
carrying threatened or endangered designations: bog turtle, small - anthered bittercress and red - cockaded woodpecker.
Although potentially - suitable habitat for bog turtle likely exists in the larger vicinity, the project area does not contain
wetlands or similarly - suitable habitat. Accordingly, work associated with the construction of the low water ford crossing is
unlikely to adversely affect this species.
Although potentially - suitable habitat for small - anthered bittercress exists in the project area, this specie has not been
documented within the county within 20 years, and is listed as an "historic" occurrence. Accordingly, work associated
with the construction of the low water ford crossing is unlikely to adversely affect this species.
No stands of pine that were mature enough to contain suitable nesting habitat for the red - cockaded woodpecker were
observed. No tree removal will occur as a result of the project. Therefore, it is not likely that the red - cockaded
woodpecker or potential habitat will be disturbed as a result of this project.
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?
hftp://ocean.floridamarine.org/efh_coral/ims/viewer.htm
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?
Review of the State Historic Preservation Office (SHPO) GIS Web Service indicated that there were no properties
currently listed or determined eligible for listing in the National Register of Historic Places within the vicinity of the project
site that are likely to be affected.
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: The project will comply with local FEMA regulations.
8c. What source(s) did you use to make the floodplain determination? Available FEMA mapping
Page 11 of 12
PCN Form - Version 1.3 December 10, 2008 Version

Joey Lawler, P.W.S. 02.28.14
Applicant /Agent's Printed Name Applicant /Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)
Page 12 of 12
PCN Form — Version 1.3 December 10, 2008 Version

AGENT AUTHORIZATION FORM
Date: 06.10.13
Project Information
S &ME Project Name: Piedmont Natural Gas Right -of -Way Reclamation Projects
Type of Project: Right -of -Way Reclamation /Maintenance Efforts
Location: Lines 94, High Point Lateral, Fayetteville (5A), Goldsboro (5B) and
Winston Salem North Loop, as applicable
Property Owner /Representative Information
Business Name:
Mailing Address:
City, State, Zip Code
Telephone No.
Contact:
Agent Information
Business Name:
Street Address:
City, State, Zip
Code:
Telephone No.
Contact:
Piedmont Natural Gas
4720 Piedmont Row Drive
Charlotte, NC 28210
704.731.4598
Kim Kalish, Sr. Project Manager
S &ME, Inc.
9751 Southern Pine Boulevard
Charlotte, NC 28273
704.523.4726
Joey Lawler
Authorization: I, Jim Kalish of Piedmont Natural Gas
hereby authorize S &ME. Inc. to act as agent with the U.S. Army Corps of
Engineers and the N.C. Division of Water Quality pursuant to obtaining
the necessary Section 10/4041401 /Buffer permits , as applicable, related
to the above - referenced projects.
Signature: — t �, (' �' , _','
S &ME, INC. 19751 Southerp(Pine Blvd/ Charlotte, NC 282731 p 704.523.4728 f 704.525.39531 www.smeinc.com

APPENDIX II:
SITE PHOTOGRAPHS

Photo 1: View of ROW facing east towards toward Mill Creek.
r� `P.
Photo 2: View of Mill Creek at proposed crossing location facing east.
Taken by: JoL SITE PHOTOGRAPHS
Checked by: JBH Mill Creek Low water Ford Crossing
Winston - Salem, North Carolina
Date Taken: 01.17.2014
Project No.: 4335 -14 -033 Photo Page 1 of 2

Photo 3: View of Mill Creek at proposed crossing location facing downstream.
4
3�Xy
L
.14 �..--
T
all
"-
`L''r 1
M
Photo 4: View of Mill Creek at crossing location facing west.
SITE PHOTOGRAPHS
Mill Creek Low Water Ford Crossing
Winston - Salem, North Carolina
Vo.: 4335 -14 -033 Photo Page 2 of 2

APPENDIX III:
REQUEST FOR PRELIMINARY JD AND SUPPORTING INFORMATION

PRELIMINARY JURISDICTIONAL DETERMINATION FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JURISDICTIONAL
DETERMINATION (JD): 02.28.14
B. NAME AND ADDRESS OF PERSON REQUESTING PRELIMINARY JD:
JOEY LAWLER, PWS
S &ME, INC.
9751 SOUTHERN PINE BOULEVARD
CHARLOTTE, N.C. 28273
B. DISTRICT OFFICE, FILE NAME, AND NUMBER: MILL CREEK LOW
WATER FORD CROSSING
C. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
PNG PLANS TO CONSTRUCT A LOW WATER FORD -TYPE EQUIPMENT
CROSSING AT A SINGLE LOCATION ALONG MILL CREEK. THE
PROPOSED CROSSING WILL BE LOCATED WITHIN PNG'S EXISTING
NATURAL GAS PIPELINE RIGHT -OF -WAY (ROW). THE SITE IS LOCATED
WITHIN THE AE ZONE OF MILL CREEK'S FLOODPLAIN, AS INDICATED
BY FIRM PANEL NO. 3710680600J. THE LOCATION OF THE PROJECT
AREA IS DEPICTED ON THE SITE VICINITY MAP (FIGURE 1), THE
APPLICABLE SECTION OF THE RURAL HALL, N.0 (1994) AND WINSTOW
SALEM WEST, N.C. (1994) USGS TOPOGRAPHIC MAPS (FIGURE 2), AND
A2010 AERIAL PHOTOGRAPH (FIGURE 3). .
(USE THE ATTACHED TABLE TO DOCUMENT MULTIPLE WATERBODIES
AT DIFFERENT SITES)
State: NORTH CAROLINA County /parish /borough: FORSYTH
City: WINSTON -SALEM
Center coordinates of site (lat /long in degree decimal format):
Lat. 36.132269 N, Long. - 80.335411
Universal Transverse Mercator: 17N, NAD83 NC STATE PLANE
Name of nearest waterbody: MILL CREEK
Identify (estimate) amount of waters in the review area:
Non - wetland waters: 50 LF (MILL CREEK)
Cowardin Class: RIVERINE
Stream Flow: 50 LF
Wetlands: 0
Cowardin Class: N/A

Name of any water bodies on the site that have been identified as Section 10
waters: NONE
Tidal: N/A
Non - Tidal: N/A
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT
APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s)
1. The Corps of Engineers believes that there may be jurisdictional waters of the
United States on the subject site, and the permit applicant or other affected party
who requested this preliminary JD is hereby advised of his or her option to
request and obtain an approved jurisdictional determination (JD) for that site.
Nevertheless, the permit applicant or other person who requested this
preliminary JD has declined to exercise the option to obtain an approved JD in
this instance and at this time.
2. In any circumstance where a permit applicant obtains an individual permit, or
a Nationwide General Permit (NWP) or other general permit verification requiring
"pre- construction notification" (PCN), or requests verification for a non - reporting
NWP or other general permit, and the permit applicant has not requested an
approved JD for the activity, the permit applicant is hereby made aware of the
following: (1) the permit applicant has elected to seek a permit authorization
based on a preliminary JD, which does not make an official determination of
jurisdictional waters; (2) that the applicant has the option to request an approved
JD before accepting the terms and conditions of the permit authorization, and
that basing a permit authorization on an approved JD could possibly result in less
compensatory mitigation being required or different special conditions; (3) that
the applicant has the right to request an individual permit rather than accepting
the terms and conditions of the NWP or other general permit authorization; (4)
that the applicant can accept a permit authorization and thereby agree to comply
with all the terms and conditions of that permit, including whatever mitigation
requirements the Corps has determined to be necessary; (5) that undertaking
any activity in reliance upon the subject permit authorization without requesting
an approved JD constitutes the applicant's acceptance of the use of the
preliminary JD, but that either form of JD will be processed as soon as is
practicable; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Corps
permit authorization based on a preliminary JD constitutes agreement that all
wetlands and other water bodies on the site affected in any way by that activity
are jurisdictional waters of the United States, and precludes any challenge to
such jurisdiction in any administrative or judicial compliance or enforcement

action, or in any administrative appeal or in any Federal court; and (7) whether
the applicant elects to use either an approved JD or a preliminary JD, that JD
will be processed as soon as is practicable. Further, an approved JD, a proffered
individual permit (and all terms and conditions contained therein), or individual
permit denial can be administratively appealed pursuant to 33 C.F.R. Part 331,
and that in any administrative appeal, jurisdictional issues can be raised (see 33
C.F.R. 331.5(a)(2)). If, during that administrative appeal, it becomes necessary
to make an official determination whether CWA jurisdiction exists over a site, or
to provide an official delineation of jurisdictional waters on the site, the Corps will
provide an approved JD to accomplish that result, as soon as is practicable.
This preliminary JD finds that there "may be" waters of the United States on the
subject project site, and identifies all aquatic features on the site that could be
affected by the proposed activity, based on the following information:
SUPPORTING DATA. Data reviewed for preliminary JD (check all that
apply) - checked items should be included in case file and, where checked
and requested, appropriately reference sources below):
® Maps, plans, plots or plat submitted by or on behalf of the
applicant /consultant: SEE ATTACHED FIGURES
® Data sheets prepared /submitted by or on behalf of the
applicant /consultant.
❑ Office concurs with data sheets /delineation report.
❑ Office does not concur with data sheets /delineation report.
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
® U.S. Geological Survey map(s). Cite scale & quad name: RURAL HALL,
N.0 (1994) AND WINSTON -SALEM WEST, N. C. (1994)
® USDA Natural Resources Conservation Service Soil Survey. Citation:
FORSYTH COUNTY, NC.
❑ National wetlands inventory map(s). Cite name:
❑ State /Local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100 -year Floodplain Elevation is: (National Geodectic Vertical Datum of
1929)
® Photographs: ® Aerial (Name & Date): SEE ATTACHED FIGURES
or ® Other (Name & Date): SEE S &ME REPRESENTATIVE SITE
PHOTOGRAPHS
❑ Previous determination(s). File no. and date of response letter:.
® Other information (please specify): SEE ATTACHED WATERS UPLOAD
SHEET.
3

IMPORTANT NOTE: The information recorded on this form has not
necessarily been verified by the Corps and should not be relied upon for
later jurisdictional determinations.
Signature and date of
Regulatory Project Manager
(REQUIRED)
See attached Agent Authorization
Signature and date of
person requesting preliminary JD
(REQUIRED, unless obtaining the
signature is impracticable)

USACE Waters Upload Sheet
Mill Creek Low Water Ford Crossing
Project No. 4335 -14 -033
02.28.2014
Waters Name
Cowardin Code
HGM Code
Area
(acres)
Linear (ft)
Waters Types
Latitude
(dd nad83)
Longitude
(dd nad83)
Local—Waterway
Mill Creek
RIVERINE
50
RPW
36.13242
- 80.335246
Mill Creek

USACOE AID # DWQ # Site # (indicate on attached map)
„■„ STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment:
1. Applicant's Name: Piedmont Natural Gas 2. Evaluator's name: Joey Lawler
3. Date of Evaluation: 01.17.2014
5. Name of stream: Mill Creek
7. Approximate drainage area:
9. Length of reach evaluated:
>500 acres
100 if
4. Time of Evaluation: - 10:30
6. River basin: Pee -Dee
8. Stream order: > 3rd
10. County: Forsyth
11. Site coordinates (if known): prefer in decimal degrees 11. Subdivision name (if any): N/A
Latitude (ex. 34.872312): 36.13240 Longitude (ex. - 77.556611 - 80.33524
Method location determined Topo Sheet Ortho (Aerial Photo /GIS) Other GIS Other:
13. Location of reach under evaluation (note the nearby roads and landmarks and attach a map identifying stream(s) location):
The site is located east of Shattalon Drive, north of Petree Road and south of Ryan Way in the City of Winston Salem, Forsyth County, North
Carolina. The segment of Mill Creek assessed crosses PNG's existing 50 -foot wide gasline ROW immediately approximately one river -mile
upstream of its confluence with Muddv Creek.
14. Proposed channel work (if any): Construction of low water ford crossing
15. Recent weather conditions: Rain within last several days
16. Site conditions at time of visit: Normal
17. Identify any special waterway classification known: Section 10 Tidal Waters Essential Fisheries Habitat
Trout Waters Outstanding Resource Waters
18. Is there a pond or lake located upstream of the evaluation point?
19. Does the channel appear on a USGS quad map? YES NO
25 % Residential
21. Estimated watershed land use:
Nutrient Sensitive Waters Water Supply Watershed
YES NO If yes, estimate the water surface area:
20. Does channel appear on USDA Soil Survey: YE NO
10 % Commercial % Industrial 30 % Agricultural
(I -IV)
35 % Forested % Cleared/Logged % Other
22. Bankfull width: 25 23. Bankfull height (from bed to top of bank):
4.5
24. Channel slope down center of stream: Flat (0 -2 %) X Gentle (24%) Moderate (4 -10 %) Steep ( >10 %)
25. Channel sinuosity: Straight X Occasional bends Frequent meander Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on location, terrain,
vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points to each characteristic within the
range shown for the ecoregion. Page 3 provides a brief description of how to review the characteristics identified in the worksheet. Scores should
reflect an overall assessment of the stream reach under evaluation. If a characteristic cannot be evaluated due to site or weather conditions, enter 0 in
the scoring box and provide an explanation in the comment section. Where there are obvious changes in the character of a stream under review (e.g.,
the stream flows from a pasture into a forest), the stream may be divided into smaller reaches that display more continuity, and a separate form used to
evaluate each reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 65 Comments:
Evaluators Signature: i` - Date: 01.17.2014
d
This channel evaluation form is inte ded to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream quality.
The total score resulting from the completion of this form is subject to USACE approval and does not imply a particular
mitigation ratio or requirement. Form subject to change -version 06/03. To Comment, please call 919 - 876 -8441 x 26.
1

STREAM QUALITY ASSESSMENT WORKSHEET
*These characteristics are not assessed in coastal streams
ECOREGION POINT RANGE
#
CHARACTERISTICS
SCORE
Coastal
Piedmont
Mountain
1
Presence of flow / persistent pools in stream
0 -5
0 -4
0 -5
4
(no flow or saturation = 0; strong flow = max points)
2
Evidence of past human alteration
0 -6
0 -5
0 -5
3
(extensive alteration = 0; no alteration = max points)
3
Riparian zone
0 -6
0 -4
0 -5
3
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0 -5
0 -4
0 -4
3
(extensive discharges = 0; no discharges = max points)
.�
5
Groundwater discharge
0 -3
0 -4
0 -4
3
(no discharge = 0; springs, seeps, wetlands, etc. = max points)
6
Presence of adjacent floodplain
0 -4
0 -4
0 -2
4
(no floodplain = 0; extensive floodplain = max points)
7
Entrenchment / floodplain access
0 -5
0 -4
0 -2
2
(deeply entrenched = 0; frequent flooding = max points)
8
Presence of adjacent wetlands
0 -6
0 -4
0 -2
2
(no wetlands = 0; large adjacent wetlands = max points)
9
Channel sinuosity
0 -5
0 -4
0 -3
2
(extensive channelization = 0; natural meander = max points)
10
Sediment input
0 -5
0 -4
0 -4
1
(extensive deposition= 0; little or no sediment = max points)
11
Size & diversity of channel bed substrate
NA*
0 -4
0 -5
3
(fine, homogenous = 0; large, diverse sizes = max points)
12
Evidence of channel incision or widening
0 -5
0 -4
0 -5
2
y�
(deeply incised = 0; stable bed & banks = max points)
13
Presence of major bank failures
0 -5
0 -5
0 -5
2
(severe erosion = 0; no erosion, stable banks = max points)
14
Root depth and density on banks
0 -3
0 -4
0 -5
3
(no visible roots = 0; dense roots throughout = max points)
15
Impact by agriculture, livestock, or timber production
0 -5
0 -4
0 -5
4
(substantial impact =0; no evidence = max points)
16
Presence of riffle - pool /ripple -pool complexes
0 -3
0 -5
0 -6
3
(no riffles /ripples or pools = 0; well - developed = max points)
17
Habitat complexity
0 -6
0 -6
0 -6
3
(little or no habitat = 0; frequent, varied habitats = max points)
18
Canopy coverage over streambed
0 -5
0 -5
0 -5
3
P
(no shading vegetation = 0; continuous canopy = max points)
19
Substrate embeddedness
NA*
0 -4
0 -4
3
(deeply embedded = 0; loose structure = max)
20
Presence of stream invertebrates (see page 4)
0 -4
0 -5
0 -5
4
(no evidence = 0; common, numerous types = max points)
21
Presence of amphibians
0 -4
0 -4
0 -4
3
(no evidence = 0; common, numerous types = max points)
O
22
Presence of fish
0 -4
0 -4
0 -4
2
(no evidence = 0; common, numerous types = max points)
�
23
Evidence of wildlife use
0 -6
0 -5
0 -5
3
(no evidence = 0; abundant evidence = max points)
Total Points Possible
100
100
100
65
TOTAL SCORE (also enter on first page)
*These characteristics are not assessed in coastal streams

APPENDIX IV:
CONSTRUCTION DETAIL EXHIBIT

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FLAT GRADE TRANSITION
12 -FT. WIDE BY 15 -FT. LONG
w,
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0 \ \x.15 30 6C
FEET )
APPROXIMATE CROSSING LOCATION
CONCEPTUAL FORD SURFACING
.11- AS SHOWN UF1I t. 2/19/14
���� PRELIMINARY GRADING PLAN FIGURE NO.
PROJECT NO. DRAWN BY A
4335 -14 -033 CHR MILL CREEK LOW WATER FORD CROSSING
CHECKED BY: WWW.SMEINC.COM PIEDMONT NATURAL GAS
JSR ENGINEERING LICENSE NO: F -0176 FORSYTH COUNTY, NORTH CAROLINA
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Q
0