20140408 Ver 1_Application_20140423

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STATE OF NORTH CAROLINA
DEPART'MENT OF TRANSPORTATION
PAT L. MCCRORY
GOVERNOR
April 23, 2014
Mr. Steven Kichefski
Asheville Regulatory Field Office
US Army Corps of Engineers
I51 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
ANTHONYJ.TATA
SECRE'IARY
SUBJECT: Pipe Replacement on SR 2009 (Green Chapman Road), Gaston County
Dear Mr. Kichefski:
The North Carolina Department of Transportation requesTS authorization to replace a
deteriorating pipe on SR 2009 (Green Chapma� Road) in Gaston County. NCDOT proposes to
replace the existing 30", 54-foot CMP with a 42", 55-foot steel pipe on same location. Due to the
pipe's location on a dead-end road, the new pipe will be installed by boring/jacking so as to allow
ingress/egress for the homeowners. A 37-ft long x 12-ft wide staging area will be located on the
downstream side of the new pipe. The section of channel disturbed by the boring machine will be
reconstructed. Coir fiber matting will be utilized to stabilize the channel and banks. The
existing pipe is perched and on a 4% slope, the new pipe will be installed at a 3% slope, but will
remain slightly perched. A�ten-foot rock ladder will be constructed at outleY to allow limited
aquaric passage. Due to the existing site conditions, NCDOT requests a waiver from the
Regional Condition 2(b)(e) permit depth specification, for the construction of this project.
Five feet of riprap will be used at the pipe inlet and outlet. A temporary cofferdam pumping
system 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 scope of the work involves 55 feet of perxnanent impacts (QO feet stream reconstrucrion + IS
feet riprap impacts, rock ladder and structure stabilization) to an unnamed tributary to South Fork
Catawba River, which is classified as a Class WS-V Watershed by the NC Division of Water
Resources.
The project is not located within '/� mile of any critical watershed area nor is SR 2009 a rural or
urban arterial; therefore, hazazdous spill basins are not required. Enclosed is Yhe hazardous spill
basin checklist This office has conducted a GIS and field survey for ihe project for historical
sites and threatened/endangered species sites. No sites listed on The NaYional Register of Historic
Places are located in the vicinity of the project nar did there appear to be any eligible structures.
This office has conducted a GIS and field survey for the project threatened/endangered species.
The federally listed species for Gaston County (USFWS listed date September 22, 2010) include
Schweinitz's sunflower (Helianthus schweinitzii) and the bog turtle (Glyptemys muhlenbergie)-

SR 2009 (Green Chapman Road)
Page 2
Apri123, 2014
(T/SA- Threatened due Yo similarity of appearance). National Heritage Program records documenY
the nearest sunflower location 4.6 miles northeast of flie proposed project area. The sunflower
is usually found in upland open azeas protected from shade or excessive competition.
There is little habitat located in the urban, residential neighborhood. Natural Heritage
Program records document the nearest bog turtle location approximately 6.5 miles northwest of
the proposed project area. Bog turtles are typically found in bogs, marshes, and wet pastures.
There is no suiYable habitat located within the project footprint. T/SA species are not subject to
Section 7 consultarion; however, no impact on this species is anficipated.
I have enclosed a pre-construction notification for a NW#3, sketches of planned activities and
location maps relative to the project.
Project information far the 401 Automated Payment Procedure is as follows:
• Work order number: 150456-55120005-12.20361 1-3126
• TIP#: NA
• Project Category: $240.00 Fee
Ifyou have any questions or concerns please feel free Yo coniact me at [phone]. Thank you for
your time and consideration on this matter.
Respectfully yours,
R. Chandler, P.E.
Division Engineer
Twelfth Division
BY: � / �
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Trish Beam
Division 12 Environmental Supervisor
Enclosures

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STATE OF NORTH CAROLINA
DEPAR'TMENT OF TRANSPORTATION
PA7RICK L. MCCRORY
GOVERNOR
MEMO TO: FILE
FROM: Trish Beam, Division 12 Environmental Supervisor �V
DATE: Apri122, 2014
ANTHONY7.TATA
SECRETARY
SUBJECT: Endangered/Threatened Species Survey for Pipe Replacement, SR 2009
(Green Chapman Road), Gaston County
The Division 12 Environmental Office conducted a threatened/endangered species survey
on January 28, 2014. The federally listed species far Gaston County (USFWS listed
dated September 22, 2010) include the Schweinitz's sunflower (Helianthus sclnveinitzii)
and the bog turtle (Glyptemys muhlenbergii).
Natural Heritage Program records document the nearest Schweinitz's sunflower location
approximately 4.6 miles northeast of the proposed project area. The sunflower is usually
found in upland open areas protected from shade or excessive competition. The project
azea is an urban neighborhood and there is little potential habitat within the proposed
project area and no species were observed during the site visit. No nnpact on this species
is anticipated. Natural Heritage Program records document the nearest bog turtle location
approxunately 6.5 miles northwest of the proposed project area. Bog turtles are typically
found in bogs, marshes, and wet pastures. There is no suitable habitat located within the
project footprint. T/SA species are not subject to Secrion 7 consultation; however, no
impact on this species is anticipated.

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Offce Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Noti6cation PC Form
A. A licant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps: � Section 404 Permit ❑ Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 3 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 For the record only for DWQ 401 For the record only for Corps Permit:
because written approval is not required? Certification:
❑ Yes � No ❑ Yes � No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation � Yes � No
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program.
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h ❑ Yes � No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concem (AEC)? ❑ Yes � No
2. Project Information
2a. Name of project: SR 2009 (Green Chapman Road)
2b. County: Gaston
2c. Nearest municipality / town: Belmont
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state 12203611
project no:
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: Reuben Chandler
4c. Busines s name N.C. Department of Transportation, Division 12
(if applicable):
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: [e-mail]
5. AgenUConsultant Information (if applicable)
5a. Name: Trish Beam
Sb. Business name N.C. Department of Transportation, Division 12
(if applicable):
5c. Street address: 1710 East Marion Street
Sd. Ciry, state, zip: Shelby, NC 28151
5e. Telephone no.: 704-480-9044
Sf. Fax no.: 704-480-5401
5g. Email address: [e-mail]
Page 2 of 11
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): NA
1 b. Site coordinates (in decimal degrees): Latitude: 35.2715 Longitude: - 81.0649
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: <.10 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Ut to South Fork Catawba River
proposed project:
2b. Water Quality Classification of nearest receiving water: WS-V
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:
Existing 54-foot long, 30" CMP; landuse is mostly wooded/residential land. Culvert is on paved secondary road.
3b. List the total estimated acreage of all existing wetlands on the property:
0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
100 feet
3d. Explain the purpose of the proposed project:
The purpose of the proposed work is to replace the deteriorating culvert for the safety of the travelling public.
3e. Describe the overall project in detail, including the type of equipment to be used:
The North Carolina Department of Transportation requests authorization to replace a deteriorating pipe on SR 2009
(Green Chapman Road) in Gaston County. NCDOT proposes to replace the existing 54-ft, 30" CMP with a 55-foot , 42"
steel pipe on the same alignment. The new pipe will be installed by boring/jacking. The 37-ft long by 12-ft wide staging
area will be located on the upstream side of the new pipe. After boring/jacking the new pipe in place, approximately 40
feet of stream channel will be reconstructed and stabilized with coir fiber matting. The existing pipe is perched and on a
4% slope, the new pipe will be installed at a 3% slope, but will remain slightly perched. Therefore, —10 rock ladder will be
constructed at outlet to allow limited aquatic passage. A temporary cofferdam pumping system will be used to divert the
stream around the construction site as needed. Area affected by temporary cofferdam system will be restored to pre-
project conditions. All Best Management Practices will be utilized during the course of the project. 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
of determination was made? ❑ Preliminary ❑ Final
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, 2005 Version

5. Project History
Sa. 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.
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
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)
Tem ora T
W1 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
WZ � P� T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W3 ❑ P � T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W4 ❑ P � T ❑ Yes ❑ Corps
❑ No ❑ DWQ
WS ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W6 ❑ P � T ❑ Yes ❑ Corps
❑ No ❑ DWQ
2g. Total wetland impacts
2h. Camments:
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. 3 b. 3c. 3d. 3 e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type ofjurisdiction 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 0 T Reconstruction of UT to South Fork ❑ PER � Corps 3 40
stream channel Catawba River � INT � DWQ
Rockladderat
S2 � P❑ T outleURock Ut to South Fork ❑ PER � Carps 3 15
stabilization at Catawba River � INT � DWQ
inlet
Temporary
S3 ❑ P� T cofferdam bypass UT to South Fork ❑ PER � Corps 3 75
pumping (if Catawba River � INT � DWQ
necessary)
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 *55
3i. Comments: `Permanent Impacts
Page 5 of 11
PCN Form — Version 1.3 December 10, 2008 Version

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number — (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Tem orar T
01 ❑P❑T
OZ ❑P❑T
03 ❑P�T
04 ❑P❑T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. Sc. Sd. 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
Sf. Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
Sj. 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 an impacts require miti ation, then ou 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)
Tem orar T im act re uired?
61 ❑P❑T ❑Yes
❑ No
B2 ❑ P ❑ T ❑ Yes
❑ No
B3 ❑ P ❑ T ❑ Yes
❑ No
6h. Total buffer impacts
6i. Comments:
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 the slope of the pipe, it will not be buried per regulation, so as to prevent stream destabilization.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Minimization of impacts by installing appropriate erosion control measures.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ❑ Yes � No
impacts to Waters of the U.S. or Waters of the State?
26. Ifyes, mitigazion is required by (check all that apply): ❑ DWQ ❑ Corps
❑ Mitigation bank
2c. If yes, which mitigat ion option will be used for this
project? ❑ 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 Progrem
4a. Approval letter from in-lieu fee program is attached. ❑ Yes
4b. Stream mitigation requested: linearfeet
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 ❑ 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. Tofal buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 8 of 11
PCN Form — Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identifed � 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.
Comments: ❑ Yes ❑ No
2. Stormwater Mana ement 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
apply (check all that apply): ❑ USMP
❑ Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑ No
attached?
4. DWQ Stormwater Pro ram 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)
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 Nationai 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 fnal approval
letter.) ❑ Yes ❑ No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ❑ Yes � No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ❑ Yes � No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
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, 2005 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?
Sb. Have you checked with the USFWS concerning Endangered Species Act � Yes � No
impacts?
❑ 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 and onsite feld survey (January 28, 2014).
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 panal nurnber: 3710358600J
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ApplicanUAgent's Printed Name Applicant/Agent's Sig e Date
(AgenPs 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

Pipe Replacement, SR 2009 (Green Chapman Road), Gaston County
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Vicinity Map
025 0.5 1 Miles

NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division: 1 � County: Ga�t�n Project ID: 12.203611
River Basin: Catawba Bridge No: NA
Route: SR 2009
River
Water Quality Criteria:
Stream: Ut to South Fark Catawba
Stream Crossing Blue L'me On USGS
ORW
WSI
WS II,III OR IV, Crossing Within O.Smi of W.S. Critical Area
Roadway Criteria:
Route Designation-
Arterial Urban
Arterial Rura1
Additional Site Information:
Is a Hazardous Spill Basin Required?
Yes No
r �
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Yes No
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Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997).
Yes No
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