20160384 Ver 1_401 Application_20160416

got WA7zO Office Use Only:
-° Corps action ID no.
PA10 DWQ project no.
Form Version 1.4 January 2009
Pre -Construction Notification (PCN) Form 2
A. Applicant Information dog 8
1, Processing
1 a. Type(s) of approval sought from the Corps:
Q Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 12 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps?
❑ Yes ❑X No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
❑X 401 Water Quality Certification — Regular ❑X 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 ❑X No
For the record only for Corps Permit:
❑ Yes Q 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 ❑X No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes Q No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑X No
2. Project Information
2a. Name of project:
Geitner Basin Sewer System Rehabilitation
2b. County:
Catawba
2c. Nearest municipality /town:
City of Hickory
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state project no: N/A
3. Owner Information 11111
3a. Name(s) on Recorded Deed:
See plans for parcel information uul APR 15 2018 V1
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
4�E A R E ER PE 0 AI NSG
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 10
PCN Form — Version 1.4 January 2009
M

4. Applicant Information (if different from owner)
4a. Applicant Is:
❑ Agent X❑ Other, specify: City of Hickory
4b. Name:
City of Hickory
4c. Business name
(if applicable):
n/a
4d. Street address:
1441 9th St. NE
4e. City, state, zip:
Hickory, NC 28601
4f. Telephone no.:
828-323-7427
4g. Fax no.:
828-322-1405
4h. Email address:
[e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name:
Mike Waresak
5b. Business name
(if applicable):
McGill Associates
5c. Street address:
55 Broad Street
5d. City, state, zip:
Asheville, NC 28801
5e. Telephone no.:
828-252-0575
5f. Fax no.:
828-252-2518
5g. Email address:
[e-mail]
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax PIN or parcel ID):
See Plans
1 b. Site coordinates (in decimal degrees):
Latitude: 35.71679 Longitude: 81.35086
1c. Property size:
acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Geitner Branch
2b. Water Quality Classification of nearest receiving water:
C
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:
Wooded or inert construction debris
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: 3,000
3d. Explain the purpose of the proposed project:
Replacement of existing sewer line and installation of new sewer line to replace sewer pump station
3e. Describe the overall project in detail, including the type of equipment to be used:
Conventional construction equipment, including track backhoe
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 priorphases) in thepast?
❑ Yes No ❑ Unknown
Comments:
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):
Agency/Consultant Company:
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes X❑ No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes Q No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands Q 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 impact
Type of wetland
Forested
Type of jurisdiction
Area of
Corps (404,10) or
impact
number
DWQ (401, other)
(acres)
Permanent (P) or
Tem ora T
W1 -
Choose one
Choose one
Yes/No
-
W2
Choose one
Choose one
Yes/No
-
W3
Choose one
Choose one
Yes/No
-
W4 -
Choose one
Choose one
Yes/No
-
W5 -
Choose one
Choose one
Yes/No
-
W6 -
Choose one
Choose one
Yes/No
-
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 (PER) or Type of Average Impact
number intermittent (INT)? jurisdiction stream length
Permanent (P) or width (linear
(feet) feet)
Temporary (T)
S1 T
Excavation
Geitner Branch
PER
Corps
15
10
S2
Choose one
"
S3 -
Choose one
-
-
S4 -
Choose one
-
-
S5 -
Choose one
-
-
S6 -
Choose one
-
-
3h. Total stream and tributary impacts
10
31. Comments:
Stream crossing for sub -aqueous sewer line crossing
Page 4 of 10
PCN Form — Version 1.4 January 2009

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 Area of impact (acres)
Permanent (P) or type
Temporary T
01 -
Choose one
Choose
02 -
Choose one
Choose
03 -
Choose one
Choose
04 -
Choose one
Choose
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If Pond or lake construction proposed, the complete the chart below.
5a.
5b.
5c. 5d. 5e.
Pond ID number
Proposed use or
Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond
(acres)
Flooded
Filled
Excavated Flooded
Filled
Excavated
P1
Choose one
P2
Choose one
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 you MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑ Neuse ❑ Tar -Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b.
6c.
6d.
6e.
6f.
6g.
Buffer Impact
Reason for impact
Stream name
Buffer
Zone 1
Zone 2
number —
mitigation
impact
impact
Permanent (P) or
required?
(square
(square
Temporary T
feet)
feet
131 -
Yes/No
B2 -
Yes/No
B3 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts:
61. Comments:
Page 5 of 10

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.
Stream crossing location picked to minimize excavation and tree removal
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Best current erosion control measures shall be used during creek crossing to minimize the impact to the stream, including all work being completed
within the confines of a coffer dam
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 Q 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: Choose one
Type: Choose one
Type: Choose one
Quantity:
Quantity:
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:
Choose one
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 6 of 10
PCN Form — Version 1.4 January 2009

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?
Yes Q 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 7 of 10

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
within one of the NC Riparian Buffer Protection Rules?
❑ Yes Q No
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
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:
This is not a development plan. It is a sewer installation project, replacing existing current sewer lines or removing a pump station from service
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a. In which localgovernment's jurisdiction is this project?
City of Hickory
3b. Which of the following locally -implemented stormwater management programs
apply (check all that apply):
❑ Phase II
❑ NSW
❑ USMP
❑ Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑X No
4. DWQ Stormwater Program Review
4a. Which of the following state -implemented stormwater management programs apply
(check all that apply):
❑Coastal counties
❑HQW
❑ORW
❑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 8 of 10
PCN Form — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the
0 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
❑x Yes ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. 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
❑x Yes ❑ 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 ❑X No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after -the -fact permit application?
❑Yes ❑X 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 Q 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 new sewer flow is to be generated by this project. This project is replacing existing sewer lines or installing gravity sewer to replace an existing
pump station. All treatment will be provide by the same City of Hickory WWTF that has been providing treatment
Page 9 of 10
PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
habitat?
❑ Yes ❑X No
5b. Have you checked with the USFWS concerning Endangered Species Act
impacts?
El Yes No
5c. If yes, indicate the USFWS Field Office you have contacted.
-
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
USFWS website maps
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes ❑X No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Mapping on official websites
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 ❑X 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?
official maps of historical and archaeological sites
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain? I ❑x Yes ❑ No
8b. If yes, explain how project meets FEMA requirements:
There will be no permanent structures above ground or above the creek level affecting the flood elevation. Watertight manholes will be used within the
flood plain.
8c. What source(s) did you use to make the floodplain determination?
North Carolina Floodplain mapping site
Applicant/Agent's Printed Name I Applicant/AgeXaZign
(Agent's signature Is valid only if an
Debbie D. Miler
City Clerk
Page 10 of 10
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r State of North Carolina
DWR
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources Watershed Classification Attachment (WSCAS O1-15)
Along with this form, submit a color copy of a USGS Topographic Map to identify the project area and waterbodies.
Each map or maps must show the location of the sewer system and include location identifiers where the system
traverses over or near waterbodies. The map should have location ID's for each different waterbody and
corresponding classifications should be recorded.
Include the completed form and map portions with the permit application for submittal to the appropriate review
agency. A list of the Division's regional offices, their county coverage, and contact information can be obtained from:
http://Portal.ncdenr.org/web/wa/home/ro
Location ID
Name of Waterbody'
River
Basin
Waterbody
Index No.
Waterbody
Classification
Geitner
Basin Outfall
Geitner Branch
Catawba
11-129-1-18
C
I If unnamed, indicate "unnamed tributary to X', where X is the named waterbody to which the unnamed tributary joins

I certify that as a Registered Professional Engineer in the State of
North Carolina that I have diligently followed the Division's instructions
for classifying waterbodies and that the above classifications are
inclusive of the stated project, complete and correct to the best of my
knowledge and belief.
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