20140557 Ver 1_More Info Received_20140613

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Office Use Only-
Corps action ID no.
DWQ project no
Form Version 13 Dec 10 2008
Page 1 of 11
PCN Form — Version 1 3 December 10, 2008 Version
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Pre - Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
la
Type(s) of approval sought from the
Corps
®Section 404 Permit ❑Section 10 Permit
1b Specify Nationwide Permit (NWP) number 12 or General Permit (GP) number
1c
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
le.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes ® No
For the record only for Corps Permit
❑ Yes ® No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program
❑ Yes
® No
1g
Is the project located in any of NC's twenty coastal counties If yes, answer 1h
below
❑ Yes
® No
1h Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2.
Project Information
2a
Name of project-
Sewer System Improvements Project
2b
County
Gaston
2c
Nearest municipality / town,
City of Bessemer City
2d
Subdivision name
NIA
2e
NCDOT only, T I P or state
project no
NIA
3.
Owner Information
3a
Name(s) on Recorded Deed.
City of Bessemer City
3b
Deed Book and Page No
3c
Responsible Party (for LLC if
applicable):
James Inman, City Manager, Bessemer City
JOIN .1
3d
Street address
132 W. Virginia Avenue
3e
City, state, zip.
Bessemer City, North Carolina 28016
3f
Telephone no
704 - 629 -5542
3g
Fax no
3h. Email address
jinman @bessemercity.com
Page 1 of 11
PCN Form — Version 1 3 December 10, 2008 Version
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4. Applicant Information (if different from owner)
4a Applicant is.
® Agent ❑ Other, specify
4b. Name,
4c Business name
(if applicable).
4d Street address.
4e. City, state, zip
4f Telephone no..
4g. Fax no
4h. Email address -
5. Agent/Consultant Information (if applicable)
5a. Name:
Douglas G. Chapman, PE
5b. Business name
(if applicable)
McGill Associates
5c Street address
1240 19th Street Lane NW
5d. City, state, zip
Hickory, NC 28601
5e. Telephone no -
828 - 328 -2024
5f. Fax no.
828 - 328 -3870
5g Email address-
doug .chapman @mcgiliengineers.com
Page 2 of 11

B. Project Information and Prior Project History
1.
Property Identification
1a
Property identification no. (tax PIN or parcel ID)*
1 b
Site coordinates (in decimal degrees).
See Attached List and Design Plans w/ Location Map
1c
Property size -
2.
Surface Waters
2a
Name of nearest body of water (stream, river, etc ) to
Unnamed Tributary to Long Creek
proposed project-
2b
Water Quality Classification of nearest receiving water.
C
2c.
River basin map is available at
Catawba
http• / /h2o enr state nc us /adman /maps/
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 sewer alignment through wooded areas within established residential regions of City.
3b
List the total estimated acreage of all existing wetlands on the property:
3c
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
1,025
3d
Explain the purpose of the proposed project-
The proposed project will replace segments of sanitary sewers and manholes which are aged and currently
expose the surrounding areas to Increased risk of sanitary sewer overflows. All proposed sewers will follow all
federal, state, and local standards for such systems and their construction.
3e
Describe the overall project in detail, including the type of equipment to be used
The project generally involves the construction of approximately 7,730 linear feet of gravity sewer pipelines and
manholes. All proposed sewers will be 8 -inch diameter sewer lines. The project also includes approximately 637
linear feet of sewer upgrade by pipe- bursting methods.
The new sewer lines will connect to adjacent existing segments of the sewer system which are not in need of
replacement. All creek crossing disturbances will be temporary in nature. Upon completion of the sewer line
installation across each stream, stream banks will be restored with biodegradable matting and native plant
species.
Equipment proposed for construction activities will Include track -hoes, back -hoes, tractors, other small power
equipment, and hand tools as necessary.
Page 3of11
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 /
project (including all prior phases) in the past?
Comments
❑ Yes ® No ❑ Unknown
4b.
If the Corps made the jurisdictional determination, what type
of determination was made?
❑ Preliminary ❑ Final
4c.
If yes, who delineated the jurisdictional areas?
Name (if known)- N/A
Agency /Consultant Company
Other:
4d
If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
N/A
5.
Project History
5a.
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes ® No ❑ Unknown
5b
If yes, explain in detail according to "help file" instructions
6.
Future Project Plans
6a. Is this a phased project?
❑Yes ® No
6b. If yes, explain
Page 4 of 11

C. Proposed Impacts Inventory
1. Impacts Summary
la Which sections were completed below for your project (check all that apply).
❑ Wetlands ® Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted
2a
2b.
2c.
2d.
2e
2f
Wetland impact
number —
Type of impact
Type of wetland
Forested
Type of jurisdiction
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non -404, other)
(acres)
Temporary T
❑ Yes
❑ Corps
W1 El P ❑ T
❑ No
❑ DWQ
El Yes
El Corps
W2 El P ❑ T
❑ No
❑ DWQ
❑ Yes
❑ Corps
W3 ❑ P ❑ T
❑ No
❑ DWQ
❑ Yes
❑ Corps
W4 ❑ P r-1 T
❑ No
❑ DWQ
El Yes Yes
❑
W5 ❑ P ❑ T
❑ No
❑ DWQ
El
Corps
W6 ❑ P ❑ T
El No
El
❑ DWQ
2g. Total wetland impacts
2h Comments
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted
3a 3b 3c 3d 3e 3f 3g
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
length
number - (PER) or (Corps - 404, 10 stream
width (linear
Permanent (P) or intermittent DWQ — non -404,
(INT)? (feet) feet)
Temporary (T) other)
S1 ❑ P ®T
Temp Stream
Crossing
UT to Long Creek
® PER
❑ INT
® Corps
❑ DWQ
10
40
® PER
® Corps
S2 ❑ P F1 T
❑ INT
❑ DWQ
® PER
® Corps
S3 ED] P ❑ T
❑ INT
❑ DWQ
® PER
® Corps
S4 El ❑ T
❑ INT
❑ DWQ
❑ PER
F1 Corps
S5 ❑ P ❑ T
❑ INT
❑ DWQ
El PER
El Corps
S6 ❑ P ❑ T
❑ INT
❑ DWQ
3h Total stream and tributary impacts
40
31 Comments
Page 5 of 11

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
impact number —
Name of waterbody
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P)
or Temporary T
01 ❑P ❑T
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
4f. Total open water impacts
4g Comments*
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a
5b
5c
5d
5e
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose of
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
number
pond
P1
P2
5f. Total
5g. Comments*
5h Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
51 Expected pond surface area (acres),
5j Size of pond watershed (acres)
5k Method of construction,
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below If yes, then individually list all buffer impacts
below If any impacts require mitigation, then ou MUST fill out Section D of this form
6a.
❑ Neuse ❑ Tar - Pamlico ❑ Other
Project is in which protected basin? N/A
❑ Catawba ❑ Randleman
6b
6c
6d
6e
6f
6g.
Buffer impact
number—
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P)
for impact
Stream name
mitigation
(square feet)
(square feet)
or Temporary T
required?
❑Yes
B1 ❑ P ❑ T
❑ No
El Yes
B2 ❑P ❑T
❑ No
❑Yes
B3 ❑P ❑T
❑ No
6h Total buffer Impacts
6i Comments
Page 6 of 11

D. Impact Justification and Mitigation
1. Avoidance and Minimization
la Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The most viable and feasible alternative for crossing the streams Is to do so temporarily, with as little impact to
surrounding stream beds, stream banks, and vegetation as possible.
b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Disturbed areas affecting the stream banks will be graded at a 2:1 maximum slope, tying into the existing
ground, planted with temporary and native grass seed and stabilized with a biodegradable erosion control
matting.
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
❑ Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
3c Comments-
4. Complete if Making a Payment to In -lieu Fee Program
4a Approval letter from in -lieu fee program is attached
❑ Yes
4b. Stream mitigation requested.
linear feet
4c If using stream mitigation, stream temperature.
❑ warm ❑ cool ❑cold
4d Buffer mitigation requested (DWQ only)
square feet
4e Riparian wetland mitigation requested
acres
4f Non - riparian wetland mitigation requested
acres
4g Coastal (tidal) wetland mitigation requested.
acres
4h Comments
Page 7 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? If you will have to fill out this entire form — please
contact the State for more information
El Yes ® No
6b If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation Calculate the
amount of mitigation required.
Zone
6c
Reason for impact
6d
Total impact
(square feet)
Multiplier
6e
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1 5
6f Total buffer mitigation required:
6g If buffer mitigation is required, discuss what type of mitigation is proposed (e g , payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund)
6h Comments*
Page 8 of 11

E.
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
1a.
Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes ® No
within one of the NC Riparian Buffer Protection Rules?
lb
If yes, then is a diffuse flow plan included? If no, explain why
❑ Yes ❑ No
Comments,
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
NIA %
2b.
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c
If this project DOES NOT require a Stormwater Management Plan, explain why All existing topographic features will be
restored to their original condition and the proposed construction activities will not require
tying to existing storm water
drainage structures
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?
Cabarrus County
❑ Phase II
❑ NSW
3b
Which of the following locally - implemented stormwater management programs
El USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other.
3c Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4. DWQ Stormwater Program Review
❑ Coastal counties
❑ HQW
4a
Which of the following state - implemented stormwater management programs apply
❑ ORW
(check all that apply)
❑ Session Law 2006 -246
❑ Other
4b
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes No
❑
attached?
5.
DWQ 401 Unit Stormwater Review
5a
Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 9 of 11
PCN Form — Version 1 3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la Does the project involve an expenditure of public (federal /state /local) funds or the
® Yes ❑ No
use of public (federal /state) land'?
1 b If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (if so, attach a copy of the NEPA or SEPA final approval
❑ Yes El No
letter )
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) NIA
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.
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 is generated from this sewer replacement project but all sewer conveyed by the project is ultimately
treated at the City of Gastonia's Crowder's Creek WWTP
Page 10 of 11
PCN Form —Version 1 3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ® No
impacts?
El 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?
http:// www .fws.gov /nc- es /es /countyfr.htmi
6. Essential Fish Habitat (Corps Requirement)
6a WIII 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?
http://www.ncdenr.org/web/wq
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a WIII 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?
http: /lwww hpo.ncdcr.ciov /, http: / /www.ncnhp.org
B. Flood Zone Designation (Corps Requirement)
8a. WIII 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 maps
Douglas G. Chapman, PE
5/30/2014
Applicant/Agent's Printed Name
Date
Appli a t/Agent's gftature
(Agent's signature is valid nl if an autho ation letter from the applicant
s provided
Page 11 of 11

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SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO.
STREET ADDRESS
PLAN N0. PARCEL ID:
132 W. Virginia Avenue
Please print: �►
Property Owner: ` �fy c��� y.�PsSL�/�L-.0 a�
Property Owner: J 4oy ����► � �� ���y��
The undersigned, registered property owners of the above noted property, do hereby authorize
CC* , of /'(% �� �SSn PiQl � 4 i
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone: �%�` (A2F''55'Zfo2
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
thorized Signature Authorized Signature
Date: 572 Yjll Date: