20211641 Ver 2_Eng_Form_4345_2012OCT signed_20220930

U.S. ARMY CORPS OF ENGINEERS
APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT
OMB APPROVAL 003
EXPIRES: 28 FEBRURUARY RY 20 2013
33 CFR 325. The proponent agency is CECW-CO-R.
Public reporting for this collection of information is estimated to average 11 hours per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding
this burden estimate or any other aspect of the collection of information, including suggestions for reducing this burden, to Department of Defense,
Washington Headquarters, Executive Services and Communications Directorate, Information Management Division and to the Office of Management and
Budget, Paperwork Reduction Project (0710-0003). Respondents should be aware that notwithstanding any other provision of law, no person shall be
subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please DO NOT
RETURN your form to either of those addresses. Completed applications must be submitted to the District Engineer having jurisdiction over the location of
the proposed activity.
PRIVACY ACT STATEMENT
Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research, and Sanctuaries
Act, Section 103, 33 USC 1413; Regulatory Programs of the Corps of Engineers; Final Rule 33 CFR 320-332. Principal Purpose: Information provided on
this form will be used in evaluating the application for a permit. Routine Uses: This information may be shared with the Department of Justice and other
federal, state, and local government agencies, and the public and may be made available as part of a public notice as required by Federal law. Submission
of requested information is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit be issued. One set
of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this application (see
sample drawings and/or instructions) and be submitted to the District Engineer having jurisdiction over the location of the proposed activity. An application
that is not completed in full will be returned.
(ITEMS 1 THRU 4 TO BE FILLED BY THE CORPS)
1. APPLICATION NO.
2. FIELD OFFICE CODE
3. DATE RECEIVED
4. DATE APPLICATION COMPLETE
(ITEMS BELOW TO BE FILLED BYAPPLICANT)
5. APPLICANT'S NAME
8. AUTHORIZED AGENT'S NAME AND TITLE (agent is not required)
First - Jeffrey Middle -Brian Last - McClanahan
First - Brandon Middle -James Last - Phillips
Company - Charlotte Water
Company - Habitat Assessment and Restoration Professionals
E-mail [e-mail]
E-mail [e-mail]
6. APPLICANT'S ADDRESS:
9. AGENT'S ADDRESS:
Address- 5100 Brookshire Blvd
Address- 301 McCullough Dr. Suite 400
City - Charlotte State - NC Zip - 28216 Country -USA
City - Charlotte State - NC Zip - 28262 Country -USA
7. APPLICANT'S PHONE NOs. w/AREA CODE
10. AGENTS PHONE NOs. w/AREA CODE
a. Residence b. Business c. Fax
a. Residence b. Business c. Fax
704 995-7489
704 928-6828 704 841-2447
STATEMENT OF AUTHORIZATION
11. 1 hereby authorize, Brandon Phillips - HARP to act in my behalf as my agent in the processing of this application and to furnish, upon request,
supplemental information in support of this permit application.
N Z 9/30/2022
SI ATURE OF APPLICANT DATE
NAME, LOCATION, AND DESCRIPTION OF PROJECT OR ACTIVITY
12. PROJECT NAME OR TITLE (see instructions)
Derita Branch Tributary Sanitary Sewer Improvements Phase 2
13. NAME OF WATERBODY, IF KNOWN (if applicable)
14. PROJECT STREET ADDRESS (if applicable)
Derita Branch
Address NA Linear Sewer project along Derita Branch
15. LOCATION OF PROJECT
Latitude: -N 35.25033 Longitude: -W-80.809823
City - Charlotte State- NC Zip-
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions)
State Tax Parcel ID NA Municipality
Section - Township - Range -
ENG FORM 4345, OCT 2012 PREVIOUS EDITIONS ARE OBSOLETE. Page 1 of 3

17. DIRECTIONS TO THE SITE
The southern terminus of the Derita Branch Tributary Sanitary Sewer alignment is located near the intersection of N Tryon Street (US 29/
NC 49) and Atando Avenue. From Charlotte, take N Tryon Street north to the intersection with Atando Avenue. The northern terminus of
the sewer alignment is located near the intersection of N Graham Street and W Sugar Creek Road. From Charlotte, take N Graham Street
north to the intersection with W Sugar Creek Road. The sewer alignment follows the Derita Branch stream corridor.
18. Nature of Activity (Description of project, include all features)
The proposed Phase 2 Derita Branch Tributary Sanitary Sewer Improvements Project corridor alignment starts from the existing sanitary
sewer Phase 1 improvements area located near the intersection of N Tryon Street and Atando Avenue. The sewer improvements alignment
extends north along Derita Branch and crosses multiple wetland areas and tributaries of Derita Branch, much of which is previously
impacted and maintained wetland areas within the existing sewer easement. Areas of new sewer easement are required to move the sewer
away from the meanders of Derita Branch that are now encroaching into portions of the existing sewer easement. The main line will be
upsized from 8", 12" and 15" lines to 18", 24" and 30" lines. The new lines will be made of DIP and C-900 DR25 PVC pipes. The line will
be installed by open -cut and by boring. The line is approximately 18,000 feet long, has 5- and 6-foot manholes, and will have a six -foot -
wide trench. The line will be dug in place and aerial sewers will be buried to lower the risk of failing. Please see ENG FORM 4345
SUPPLEMENTAL INFORMATION for additional information.
19. Project Purpose (Describe the reason or purpose of the project, see instructions)
The Derita Branch Tributary Sanitary Sewer Improvements Project Phase 2 will serve the demands of the growing area. The overall need is
to replace aged and failing infrastructure since the existing sewer is under capacity. It also has high levels of infiltration and inflow. The
existing sewer was built in the 1960's and 1970's and the manholes leak groundwater. The creek has meandered and is putting the sewer
pipe at risk of being exposed and falling into the creek. Construction is projected to begin in early spring 2023, and the project will take
approximately 18 months to complete.
USE BLOCKS 20-23 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED
20. Reason(s) for Discharge
Clayey soil and rock will be excavated, removed from the trench and hauled off -site. It is estimated that approximately 3,900 cubic yards
of bedding stone will be used around the sewer pipe in the wetlands. This is in order to support and stabilize the pipe. The remaining
portion of the ditch will be filled using native soil that was dug from the ditch. The top 12 inches of the wetland topsoil will be removed,
stockpiled and replaced. In order to match the pre -construction contours, the excess soil displaced by the pipe and bedding stone will be
hauled off. The original contours will be restored. Erosion control devices will be used per state requirements. We do not anticipate any
basins to be constructed. Please see ENG FORM 4345 SUPPLEMENTAL INFORMATION for additional information.
21. Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards:
Type Type Type
Amount in Cubic Yards Amount in Cubic Yards Amount in Cubic Yards
bedding stone = 3,901 CY Pipe displacement volume = 1,007 CY See ENG FORM 4345 SUPPLEMENTAL I
22. Surface Area in Acres of Wetlands or Other Waters Filled (see instructions)
Acres 3.18
or
Linear Feet
23. Description of Avoidance, Minimization, and Compensation (see instructions)
The existing sewer crosses Derita Creek and unnamed tributaries many times. The new alignment will cross the stream fewer times and
will reduce operational impacts to the stream. Existing aerial lines will be buried below the creek bottom. The alignment was selected to
avoid streams and ponds as much as possible and to follow the general drainage basin of the existing sewer. Mitigation will be provided
through the purchase of credits from the Charlotte -Mecklenburg Storm Water Services Umbrella Stream and Wetland Mitigation Bank.
ENG FORM 4345, OCT 2012 Page 2 of 3

24. Is Any Portion of the Work Already Complete? QYes F—]No IF YES, DESCRIBE THE COMPLETED WORK
The Phase 1 portion of the project has been permitted (SAW-2021-02426). The Phase I Derita Branch Tributary Sanitary Sewer
Improvements Project corridor alignment starts from the existing sanitary sewer located in a grassed area next to Little Sugar Creek and
north of Cullman Avenue, within a contaminated industrial site. The corridor extends to the east, parallel to Little Sugar Creek and crosses
perpendicular under Little Sugar Creek and into a forested upland. A branch line of the sewer crosses Derita Branch to tie to the existing
sewer. The sewer corridor then extends between Derita Branch and existing development to North Tryon Street. The Phase 2 portion of the
project extends north from the Phase 1 portion of the project.
25. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (if more than can be entered here, please attach a supplemental list).
a. Address- Please see ENG FORM 4345 SUPPLEMENTAL INFORMATION
City - State - Zip -
b. Address -
City - State - Zip -
c. Address -
City - State - Zip -
d. Address -
City - State - Zip -
e. Address -
City - State - Zip -
26. List of Other Certificates or Approvals/Denials received from other Federal, State, or Local Agencies for Work Described in This Application.
AGENCY TYPE APPROVAL' IDENTIFICATION DATE APPLIED DATE APPROVED DATE DENIED
NUMBER
USACE NWP 43 SAW-2021-02426 2021-11-09 2021-11-10
NCDWR WQC 20211641 2021-11-09 2021-12-13
Would include but is not restricted to zoning, building, and flood plain permits
27. Application is hereby made for permit or permits to authorize the work described in this application. I certify that this information in this application is
complete and accurate. I further certify that I possess the authority to undertake the work described herein or am acting as the duly authorized agent of the
applicant.
LCc�L 9/30/2022
L-LSIGWURE OF APPLICANT DATE SIGNATURE OF AGENT DATE
The Application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly
authorized agent if the statement in block 11 has been filled out and signed.
18 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States
knowingly and willfully falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false, fictitious or
fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious or
fraudulent statements or entry, shall be fined not more than $10,000 or imprisoned not more than five years or both.
ENG FORM 4345, OCT 2012 Page 3 of 3