20170040 Ver 1_Permit_application_package_20170106

Transportation
January 6, 2017
Mr, Steven Kichefski
Asheville Regulatary Field Off'ice
US Army Corps of Engineers
i 51 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
ROY COOPER
cov�nor
MICHAEL L. HOi.DER
Acttng 5aretary
SUBJECT: Pipe Replacement/Removal of Fill Material from Jurisdictional Areas, NC 16
Business (just west of NC 16), Gaston County
Dear Mr. Kichefski:
The North Carolina Departznent of Transportation requests authorization to replace a failed 36"
pipe and drainage system Under NC 16 business with a 36" welded steel pipe using trenchless
installation. This will necessitate construction of a bore pit on the upper end of the existing pipe.
An approximate one-foat high sediment control stone berm will be placed around the bore pit to
prevent any overland flow from entering the pit. Water will be pumped from the bore pit, as
needed, to a silt bag and stilling basin. The existing pipe will be utilized as a conduit to run a
temporary bypass p�np hose during new pipe installation (see bypass pumping detail, plan sheet
3), A second temporary bypass will be utilized dUring the wetland cleanup phase of the project,
which will extend from the outlet of the new pipe to a point downstrealn of the wetland.
To prevent further movement of fill material downstream in the jurisdictional area and also to
contai.n any sediment during the boring/jacking of the new pipe, temporary erosion control
measures will be placed with in the wetland (coir fiber wattle barriers and baffles). A rock inlet
sediment trap type A will be placed downstream of the wetland. Additionally coir fiber wattles
will be used at vari.ous points downstream during the removal of the �ost fill material from the
stream. It will be necessary to place temporary erosion control measures in jurisdictional areas
during the project construction; therefore, NCDOT is requesting a waiver from tiie General
Condition of "No Sediment and Erosion Control Measures in WetIands or Waters". All
temporary measures will be removed within 2 months of project completion and any azeas
affected by the temporary erosion control measures wi11 be restored to natural conditions and
drainage patterns. The temporary erosion control measures will impact a 0.18 acre wetland; �25
cu�ic yarc�s of impacts to an unnamed tributary to the Catawba River, which is classified as WS-
N CA by the N.C. Division of Water Resources.
This office has conducted a GIS and field survey for the project threatened/en�dangered species
on January 4, 2017. The federally listed species for Gaston County (September 22, 20I0) include
the bog turtl.e (Glyptemys muhlenbergit�-{T/SA- Threatened due to similarity of appearance),
dwarf-flowered heartleaf (Hexastylas naniflora}-Threatened; Schweinitz's sunflower (Helianthus
schweinitzii}-Endangered; and Northern Long-eared Bat (Myotis septentrfonalis)-Threatened.
�othing Compares�.�.
State af North Ceroline � Deparhnent of Tranaportadan � Business Unit Neme
Address 1 � Addresa 2 � City, NC Zip+4
### ##lk #H## T

HWY 16
Page 2
January 6, 2017
National Heritage Program (NtiY) records document the nearest confirmed heartleaf location 0.6
miles west of the proposed project area. The heartleaf is usually found an dry to moist ravine
slopes (usually north facing and of the oak-hickory-pine forest type) and in boggy areas near
springheads. During field investigations, several heartleaf species was identified and potential
habitat is located within the project aa�ea. The division enviroz�umen#al off'ice, in conjunction with
U.S. Fish and Wildlife personnel, have designated the location of the three suitable access paths
for cleanup phase of project, which would avoid impacts to the heartleaf species located in the
project area. It is anticipated that tbe project can be done wi.thout impact to the heartleaf species;
however, due to the observance of a heartleaf species in close proximity to the project access
areas, the suitable habitat which encompasses the entire area, and the need for the project to
proceed priar to the habitat su�rvey window, this is a"may affect, but not �ikely to adversely
affect" call for the dwarf flowered heartleaf species. (Sea attached USFWS correspondence; tlie
off'icial consultation letter is forthcomi.ng). Prior to project commencement, a pre-construction
meeting will be held with �lae project contractor to determine if additional access points wi11 be
required for the project. If any additional areas are noted, the division environmental office will
evaluate each area for any heartleaf species and coordinate with USFWS personnel if necessary.
Natural Heritage Program records documen.t the nearest Heliantlaus Schweinitzai location
approximately 4.0 miles southeast of the proposed project area. The sunflower is usually found
in upland open areas protected from shade or excessive competition. Although the survey was
conducted outside of the optimal suu-vey window, little suitable habitat was found near the
project area and no species were observed. Natural Heritage Program recards document the
nearest bog turtle location 10.0 miles southwest of the proposed project area. Bog turtles are
typically found in bogs, marshes, and wet pastures. T/SA species are nat subject to Section 7
consultation; however, there is no suitable kabitat located within the project area and no impact
on this species is anticipated.
The Natural Heritage Prograrn records document the nearest Narthern Long Eared Bat location
approximately 37.0 miles northwest of the proposed project axea. During summer, northern long-
eared bats roast singly or in colonies underneatli bark, in cavities, or in crevices of both live and
dead trees. They may also roost in cooler places, like caves and mines. Tree sgecies may be used
based on suitability to retain bark or provide cavities or crevices. It has also been found, rarely,
roosting in structures like barns and sheds. Northern long-eared bats spend winter hibernating in
humid caves and mines. The project cleanup occurs in a wooded area, however, under
agreement with the property owner where the cleanup access points are located, no trees
are to be cut. Per the NHtP database, the closest listed undergound mine is the Keams Copper
mine, which is located 6 miles east (in Mecklenburg County) of the project site. 'There aze
currently no �own Iubernaculum or maternity roost trees in Division 12 counties for NLEB;
therefore, i�his DOT project would be exempted from incidental take under the 4(d) Rule
streanalined consultation form. I have attached a copy of the NLEB streamlined consultadon
form to satisfy the 4(d) rule requiremen�s. Per guidance from USFWS personnel,
concurrence is granted by citing the following website and a 30 day response period is waved.
h#t ://www.fws. ov/asheville/htmis/ ro'ect review/NLEB in WNC.html

HWY 16
Page 3
January 6, 2017
The National Regisier of Historic Sites was reviewed and there are no listed on the National
Register. Additionally the pipe replacement praject accurs within disturbed NCDOT right of
way.
I have enclosed a pre-construction notification for a NW#18, sketcl� of planned activities and a
location map (https://www.google.com/mapsl@35°22'S9.1."N 81°00'18.5"W) relative to the
project.
If you have a�y questions or concerns please feel free to contact me at [phone]. Thank
you for your time and consideration on this matter.
Respectfully yavrs,
Mark Stafford, P.E.
Division E�gineer
Twelfth Division�
BY: '
Trish Beam
Division 12 Environmental Supervisor
Enclosures

Office L�se Only:
Corps action ID no.
DWQ praject no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PCN} Form
A. A licant Information
1. Proc�ssing
1a. Type(s) of appro�al sought from the
Corps: � Section 404 Permit ❑ Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 18 or General Permit {GP) number:
1c. Has the NWP or GP number been �erified by the Corps? � Yes ❑ No
1 d. Type(s) of appro�al sought from the DWQ (check all that apply):
� 401 Water Qualiry Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 4�1 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1e. Is this natification solely for the record For the record only for DWQ 401 Fvr the record anly for Corps Permit:
because written approval is not required? Certification:
❑ Yes � No ❑ Yes � No
1f. Is paymeni into a mitigation bank or in-lieu fee program propased for mitigation � Yes � No
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu �
fee prograrn. �
'4g. Is the project located in any of NC's lwenty coastal caunties. If yes, answe� 1 h ❑ Y�S � No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concem (AEC)? ❑ Yes � No
2. Project Information
2a. Na�'ne of project: NC 16 Business just west of NC 16 (35°22'59.1 "N 81 °00"E8.5"W)
2b. County: Gaston
2c. Nearest municipality 1 town: Lucia
2d. 5ubdi�ision name:
2e. NCDOT only, T.I.P. or state �2,2p3611
projec# no:
S. Owner Information
3a. Name(s} on Reoorded beed: NC DOT Right of Way
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
3e. Ciry, state, zip:
3f. �elephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 11
PCN Form — Version 1.3 December 10, 2U08 Version

4. Applicant Information (if difFerent from owner�
�a. Applicant 9s: ❑ Agent ❑ Other, speci�y:
4b. Name: Mark Staffard {Di�ision Engineer)
4c. Business name N.C. Departmen# of Transportation, Di�ision 12
(if appEicable):
�d. Street address: 171 a East Marion Street
4e. Ciry, state, zip: Shelby, NC 28151
4f. Telephone na.: 7Q4-480-902D
4g. Fax no.: 704-480-5401
4h. Email address: [e-mail]�
5. AgentlConsultant Information (if applicable)
5a. Name: Trish Beam
5b. Business name N,�, Department of Transportation, Division 12
/er �.�.�I!_�LI�\.
5c. Street address:
5d. Ciry, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
1710 East Marion Street
Shelby, NC 28151
704-48D-9044
704-480-54Q1
[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
1a. Property identification no. (tax PIN or parcel ID): NA
Latitude: 35`22'S9.1 "N Longitude: -
1b. 5ite coordinates (in decimal degrees): 87°00'18.5"W
(DD.DDDDbD) (-DD.DDbD�D}
1 c. Properry size: <..10 acres
2. SurFace Waters
2a. Name af nearest body of water (stream, ri�er, etc.) to Unnamed tributarytv Catawba River
proposed praject:
2b. Water Quality Classification of nearest receiving water: WS-IV CA
2c. River basin: Catawba
3. Project Description
3a. Describe the existing condRtions on the site and the general land use in the vicinity of the project at the time of this
applicatian:
Pi�e on state maintained pa�ed roads. Landuse is designated forest land.
3b. List the #otal 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:
2000 feet
3d. Explain ihe purpose of the proposed project:
The purpose of the proposed work is to replace a deteriorating culvert for the safety of the travelling public and to remove
losk fill material.
3e. Describe the overall project in detail, including the type of equ3pment to be used:
The North Carolina Department of Transportation requests authorization to replace a failed 36" CMP on NC 16 Business
in Gaston County with a 36" pipe of same length using boringljacking method. The existing pipe will be utilized as a
bypass pipe during boring of new pipe and will be filled with flowabfe to seal. Fill material which has migrated into the
downstream wetland/stream wilf be removed from the downstream wetland utilizing mechanized equipment and from the
skream utElizing shovellbucket excar+ation.
Phased temporary cofferdam pumping systems wil! be used to divert the stream around the boringljacking construction
sites as well as around khe downstream wetland during removal of fill material. The Project will be co�strucied using
typical hearry equipment (trackhoe, backhoe, etc.)
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requssted or obtained for this property 1
project {including all prior phases) in the past? � Yes ❑ No ❑ Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type � Preliminary ❑ Final
af determination was made?
4c. ff yes, who delineated the jurisdictional areas? AgencylConsultant 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, 2008 Version

Page 4 of 11
PCfV Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts fnventory
7. Impacts Summary
1a. Which sectians were completed below for your project (check all that apply):
� Wetlands � Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacis
If there are wetland impacts proposed on the site, then complete this question for each wekland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type af jurisdiction
number — Type of Impact Type of wetland Forested (Corps - 404, 1 D Area of impact
Permanent (P) or (if known) DWQ — non�04, other) (acres)
Tem ora 7
Temporary
W1 ❑ P� T Erosion Control � Yes � Corps
Measures ❑ No � DWQ �'18
W2 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W3 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W4 ❑ P❑ T ❑ Yes ❑ Cvrps
❑ No ❑ DWQ
W5 ❑P❑T ❑Yes ❑Corps
❑ No ❑ DWQ
W6 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ bWQ
2g. Total wetEand impacts 0.18
2h. Comments:
3. 5tream Impacts
If there are perennial or intermittent stream impacts (including tamporary 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 A�erage Im�act
number - (PER) or (Gorps - 404, 'f0 stream length
Permanent (P) or intermittent DWQ — non-404, width (linear
Temparary (T) (�NT)? other) (feet} feet}
Temporary
Erosion Control UT to Ca#awba � P�R � Corps
S1 ❑ P � T Measures (Rock � �,
Inlet Sediment Rlver ❑ INT � DWQ
Trap)
S2 ❑ P� T Temporary UT to Catawba � PER � Corps 2 15a
bypass pumping River ❑ IN7 � DWQ
�
53 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S4 ❑ P❑ T ❑ p�� ❑ Corps
❑ INT ❑ pWQ
S5 ❑ P[] 7 ❑ RER ❑ Corps '
❑ INT ❑ DWQ
S6 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
3h. Total stream and tributary impacta
3i. Comments:
Page S of 11
PGN Forrrt — Version 1.3 December 10, 2008 Version

�4. Open Water Impacts
If there are proposed impacts to la�ces, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually lisk all open water impacts below.
4a. 4b. 4c. 4d• `�e•
Open water Name of waterbady
impact number — (if applicable) Type af impact Waterbody rype Area of impact (acres}
Permanent (P) or
Tem ora T
01 ❑P❑T
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
4f. Totaf open water imp�cts
4g. Commants:
5. Rond ar Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts {acres) Stream Impacts (feet) Upland
Pond ID Proposed �se or purpose (acras)
number of pond Flaoded Filled Exca�ated Flooded Filled Exca�ated Flooded
P1
P2
5% Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No 1f yes, permit ID no:
5i. Expected pond surface area (acres}:
5j. Size of pond watershed (acres}:
5k. Method of construction:
$. Buffer Impacts (for DWQ]
If projeck wili impact a protecked riparian bufFer, then complete the chart below. If yes, then indi�iduaAy list all buffer impacts
below. If an impacts require miti ation, then you MUSf fill out Section D of this form.
6a.
❑ IVeuse ❑ Tar-Pamlico Other:
Project is in which prokected basin? ❑ Catawba ❑ Randleman
Sb. 6c. 6d. 6e. 8f. 6g.
Buffer impact
number — Reason Buffer Zone 1 impact Zone 2 impact
Permanent {P} or for Stream name mitigation (square feet) (square feet)
Tem ora T im act re uired?
61 ❑P❑T ❑Yes
❑ No
B2 ❑P❑T ❑Yes
❑ No
B3 ❑P[]T ❑Yes
❑ Np
6h. Total buffer impacts
6i. Comments:
Page 6 of 11
PCN Form —Version 1.3 December 1a, 2008 Versian

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically descrEbe measures taken to a�oid or minimize the propased impacts in designing project.
1 b. 5pecifically describe measures taken to avoid or minimize the proposed impacts through constructior� techniques.
2. Compensatory Mitigation for Impacts #o Waters of the U.S. or Waters of the State
2a. �oes the project require Compensatory Mitigation far ❑ Yes � No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (checl� all that applyj: ❑ DWQ ❑ CorpS
❑ Mitigation bank
2c. If yes, which mitigation 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. Camments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval Ietter from in-lieu fee program is attached. ❑ Yes
4b. Stream mitigatian requested: linear feet
4c. If using stream mitiga#ion, stream temperature: ❑ warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only): square feek
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) we�and mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, pro�ide a description of the proposed mitigation plan.
Page 7 of 11
PCN Form — Version 1.3 December 10, 20U8 Version

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protecied riparian buffer that requires ❑ Yes � No
bufFer mitigation?
6b. lf yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount af mitigation required.
Bc. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet} {square feet)
Zone 1 3{2 for Catawba)
Zone 2 � •5
Bf. �otai buffer mitigation re�uired:
6g. If bufFer mitigation is required, discuss what type of mitigaiion is propased {e.g., payment to pri�ate mitigation bank,
permitiee responsible riparian buffer restoration, pay�nent into an appro�ed in-lieu fee fund).
6h. Comments:
Page 8 of 11
PCN Form — Version �.3 December 10, 2008 Versio�

E. Stormwater Management and Diffuse Flow Plan (required by DWQJ
1. Diftuse Flow Plan
1a. Does the projec# include or is it adjacent io protected riparian buffers identified � Yes � Na
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flaw pian included? If no, explain why.
Comments: ' ❑ Yes ❑ No
2. Stormwater Mana ement Plan
2a. What is ihe overall percent imperviousness of this project? No increase in built upon area %
2b. Does this project require a 5tormwater Management Plan? ❑ Yes � No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Complies with NCDOT's indir►idual
NPD�S perrnit NCS00�250.
2d. If this project DQES require a Stormwater Manageme�t Plan, then provide a brief, narraii�e description of the plan:
❑ Certified Loca� Govemment
2e. Who will be responsible for the review of the Starmwater Management Plan? ❑ DWQ Stormwater Program
� DWQ 4�1 Unit
3. Certified Lacal Go�ernment Stormwater Review
3a. In which local go�ernment's jurisdiction is this project? NA
❑ Phase II
3b. Which of the fallowing locally-implemented stormwater management programs ❑ NSW
apply (check all that apply): ❑ USMP
❑ Water Supply Watershed
❑ Other:
3c. Has the appro►red Storrnwater Managem�nt Plan with proof of approval been ❑ Yes ❑ No
attached?
4. DWQ Stormwatar Pr ram Reviaw
❑ Coastaf counties
❑ HQW
4a. Which of the following state-implemented stormwater ma�agement programs apply � ORW
(check all that apply): ❑ Session Law 2QD6-246
❑ Other:
4b. Has the approved Stormwater Management Plan wi#h proof of appro�al been
attached? ❑ Yes ❑ No
5. DWQ 401 Unit Stormwater Review
5a. Does the 5tormwater Management Plan meet the appropriate requirements? ❑ Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been rnet? ❑ Yes ❑ No
Page 9 of 11
PCN Form — Version 1.3 Decerr�ber 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWf� Requirement)
1a. Does the project inr►al�e an exgenditure of public (federallstatellocal) funds or the � Yes ❑ No
use of public (federallstate) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
en�ironmental document pursuant to the requirements of the National or State ❑ Yes � IVo
(North Carolina) En�ironrrsental Policy Act (NEpA15EPA)?
1 c. If you answered "yes" ta the abo�e, has the document re�iew been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ❑ Yes ❑ No
Comments:
2. Violations (DWQ Requirem�nt)
2a. Is the site in �iolation of DWQ Wetland Rules (15A NCAC 2H .0500}, Isalated
Wetland Rules (15A NCAC 2H .1300), DWQ Surtace Water or Wetland Standards, ❑ Yes � No
or Riparian Buffer Rules {15A NCAC 2B A200)?
2b. Is this an after-the-fack permii application? ❑ Yes � No
2c. If you answered "yes" to one or both of khe abave questions, provide an explanation of the �iolation{s):
3. Cumulative Impacts (DWQ RequiremeAt}
3a. Will this project (based on past and reasonably anticipated future impacts) resuit in � Yes � Na
additional development, which could impact nearby downstream water quality?
3b. If yau answered "yes" to the above, submit a qualitative or quantitative cumulatE�e impact analysis in accordance with the
most recent DWQ policy. If you answered "no," pro�ide a short narrative description.
The project is a minirrtum criteria project which has low potentiai for cumulati�elindireck impacts and will not result in
additional ci�velapment which could impact waker qua�ity.
4. 5ewage Disposal (DW4 Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) af wastewater generated from
the proposed project, or available capacity of the subject facifity.
Mo wastewater generated from project.
Pagel0af11
PCN Form — Version 1.3 December 1�, 2008 Version

5. Endangered Species and Designated Critical liabitat (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 conceming Endar�gered Species Act � Yes ❑ No
impacts?
❑ Raleigh
5c. If yes, indicate the USFWS Field �ffice you have contacted.
� Asheville
5d. What data saurces did you use to determine whether yaur site would impact Endangered Species or Designated Critical
Habitat?
NC Natural Heritage Program database and onsite surveys. See attacl�ed USFWS email. Official concurrence letter
forthcoming.
6. Essential Flsh Habitat (Corps Raquirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes � No
Bb. What data sources did yau use to determine whether yaur site would impact Essential Fish Habitat?
No salt rnarshes, oyster reefs, or seagrass beds located in �icinity of project.
7. Historic or Prehistorlc Cultural Resources (Corps Requirement]
7a. Will this project occur in or near an area that the state, federal or tribal
go�emments ha�e designated as having historic ar 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?
Re�iew of National Register site listings. The pipe replacerrtent project is located within NCDOT ROW in an already
disturbed area.
8. Fload Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain? ❑ Yes � Na
8b. If yes, explain how project meets FEMA requirements:
Sc. What source(s} did yau use to malce the floodplain determination? FEMA FIRM map number: 3710460000K; Panel 4600
http:llfris. nc.go►►Ifrisl
,��� � .���� � �� - -1 �
� �� � ��
Applicantll�qent's Printed Name ApplicantlAgent's Signature Date
(Agent's signature is valld only if an authorization letter from the applicant
is rovlded.
Page 11 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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Northern Lon -Esred Bat 4 d Rule Streamlined Consultation Form
Federal agencies should use this form for the optional streamlined consultation framework for the northern long-
eared bat {NLEB). This framework allows federal agencies to xely upon the U.S. Fish and Wildlife Service's
(USFWS) Januaty 5, 2016, intra-Service Prog�rammatic Biological Opinion {BO) on the fina14{d) rule for the
NLEB for section 7(a)(2) compliance by: (1) notifying the USFWS that an action agency will use the streamlined
framework; (2} describing the project with sufficient detai� to suppart t)�e required determinat�on; and {3) enabling
the US�W5 to track e£fects and determine if reinitiation of consultation is required per 50 CFR 402.16.
This form is not necessary if an agency determines that a proposed action will have no effect to the NLEB or if
the USFWS has concurred in writi.ng with an agency's determination that a proposed action may affect, but is not
likexy to adversely affect the NLEB (i.e., the standard informal consultation process). Actions that may cause
prohibited incidental take require separate formal consultation. Providing tlais information does not address
section 7(a){2) compliance for any other listed species.
Information to Determine 4(d) Rule
1. Does the praject occur wholly outside of the WNS Zonel?
2. Have you contacted the apprapriate agency� to determine if your proj ect is near
known hibernacula or maternit roost trees?
3. Cou1d the project disturb hilaernating NLEBs in a laiown hibernaculum?
4. Could t�e project alter the entrance or interior environnlent of a known
hibernaculum?
� 5. Does the project remove any trees within 0.25 miles of a known hibernaculum at
an time of ear?
6. Would the project cut or destroy known occupied maternity roast trees, ox any
other t�rees within a 150-foot radius from the maternity roost tree from June 1
throu�h 7uly 31.
Yau are eligible to use this form if you have answered yes to question #1 or yes to question #2 and no to
questions 3, 4, 5 ax�d 6. The remainder of the form will be used by the USFWS to track our assumptions in the
BO.
Agency and Applicant� {Name, Email, Phone No.): NCDOT, Division 12, Trish Beam,
pdbeam(a�,ncdot.�v_, 704-480-9(}44
Project 1`Tame: Pipe RepairlSediment Removal
Project Location (include coordinates if known): NC 16 Business just west of NC 16
Basic Project Description (provide narrative below or attach additional infortnation): Repair of a failed
pipe under 16 and sediment removal from downsiream wetland and strearn which occurred due to failed
pipe, Gaston County
1 httpJ/www.fws.gov/midwest/endangeredlx�amtnals/nleblpdf/WNSZone.pdf
� See http:l/www.fws.gov/midwest/endangered/maxnmals/nlebinhisites.html
3 If applicable - only needed for federal actions with applicants (e.g., for a permit, etc.) who are party to the consulta.tion.

A�encv Detennination:
By signing this form, the action agency determines that this project may affect the NLEB, but that any
resulting incidental take of the NLEB is not prohibited by the final4{d) rule.
If the USFWS does not respond within 30 days from submittal of this farm, the action agency may
presume that its determination is informed by the best available informataon and that its project
responsibilities under 7(a)(2) with respect to the NLEB are fulfilled through the USFWS January 5,
2016, Programinatic BO. The aedon agency will update this determination annually for multi-year
ac�ivities.
The action agency understands that the USFWS presumes that all activities are implemented as
described herein. The action agency will prornptly report any departures from the described activities to
the appropriate USFWS Field Office. The actian agency will provide the appropriate USFWS Field
Office with the results of any surveys conducted for the NLEB. Involved partaes will promptly notify the
appropriate USFWS Field Office upon finding a dead, injured, or sick NLEB.
�
:�.
,r' f ' .
� ,j .:
Signature: Date Submitted: —r � ' / �
4 Any activity that temporarily or permanently removes suitable farested habstat, includ�ng, but not limited to, tree remova.l
from development, energy production and tra.nsmission, mining, agriculiure, etc. {see page 4$ of the BO).
5 If the project removes less than 10 trees and the acreage is unlaiown, report the acreage as less than 0.1 acre.
6 If the activity includes tree clearing in June and July, also include those acreage in April to October.

Beam, Patricia
From:
5ent:
To:
Cc:
Subject:
Trish,
Henderson, Andrew �[e-mail]>
Thursday, January 05, 2017 12:21 PM
Beam, Patricia
Wyatt, JefFFrey L
Re: Pipe Repair/5ediment Remo�al, NC 16 Business Just West of NC 15, Gastan County
On 12/21/16, the US Fish & Wildlife Service {USFWS} was notifred by the North Carolina Department of Transportation {NCDOT}
rria email that the subject project had preliminary plans avaiiable, and NCDOT Division 12 biologists had determined the need to
establish access points during praject planning to ensure irr�pacts to en�ironmental resouroes would be minimized during project
Implementation. On 1/4/17, the USFWS {Andrew Henderson) partici�ated in a site visft with Divlson 12 Environmental Sta�F
(Trish Beam, Jeff Wyatt) ta revlew �lans, discuss project consideratlons, survey vegetation, and desfgnate potentially sensltive
areas within the project boundaries to be avoided while pipe repalr, sediment remo�al, and associated cieanup acti�ities are
aonducted.
Upon re�iew of project plan sheets, �egetative surveys, designated access paints, and based on canversation and discussion
that was held with �SFWS an site on 1�4�17, the NCDOT has incorporated sufF'iaent a�oidance and minimization measures to
sensitive resources, especially native vegetation, This includes pre-project implementation meetings with the DOT oontractor to
dlscuss the imporrance of staying withln designated access polnts� and the presence of a NCDOT Di�ision 12 Staff biologist on
site during all phases of project implement�tior� to provide feedback and guidance as needed. Additionatly, if there.are any
deviations �rom the access points previously established, prior to ground disturbance activ�ties the NCDOT would coordinate
with USFWS to discuss possible alternatives.
Based an the information provided associated with the proposed project and the incorporation of avoidance and minimizatian
measures for Dwart-flowered heartleaf a�d and its habikat, bhe USFWS concurs with your May Af�ect, Not Likely to Ad�ersely
Af�ect determination for DwarF flowered heartleaf.
As outlined in the Biologica! Opinion completed on the 4(d} rule for the Northem lang-eared bat (NLEB} on 1/5/16, and based
on information submitted i� the NLE6 streamlined consultation form, this ac6i�ity is excepted from take prohibitions for Northern
long-eared bat t}ased on the project location, because activities in the action area ('1) would not affect a known hibemation site;
(2) are nvt located within'/ mile of a known hibernation site, or; (3) are not located within a 950' radius of a known maternity
(tree) site.
Therefore, we believe the req�irements under Section 7(c) af the Endangered Specles Act (ESA) of 1973, as amended (16
U.S.C. 1531-1543}, are fulfillea. Obligatior�s under Section 7 of the ESA must be reconsidered if: (1) r�ew informatian reveals
impacts of this identiFed action that may affect listed speci�s or critical habitat in a manner not previously considered, (2} this
action is subsequently modified in a manner that was nat considered in this re�iew, or (3) a new species is listed or critical
habitat is determined that may be afFected by the identified action.
Thank yau for your cantinued coordinatlon an this project and let me know if you ha�e any further questions.
Andrew
On Thu, Jan 5, 2017 at 10:29 AM, Beam, Patricia �pdUea�n� 3a,ncdot.�> wrate:
Andr�w,

Per your site visit to the NC 16 pipe repairlsedimezit cleanup project on January 4, 2017, I have attached plan
sheets for the project. On the "snapshot" plan sheet, I have indicated the location of the three access paths that
the Division 12 environmental office with your assistance designated as suitable pathways for the sediment
cleanup effort associated with this pipe repair project. It is anticipated that the project can be done without
impact to the heartleaf species; however, due to the observance of a heartleaf species in close proximity �o the
project access areas, the suitable habitat wlv.ch encompasses the entire axea, and the need for the project to
proceed prior to the ha.bitat survey window, this is a"rnay affect, but not likely to adversely affect" call for the
dwarf flowered heartleaf species. Prior to project commencement, a pre-construction meeting will be held with
the project contractor to determine if additional access poinis will be required for the project. If any additional
areas are noted, the division environmental office will evaluate each area for any heartleaf species and
coordina�e with USFWS personnel if necessary.
The project cleanup occurs in a wooded area, however, it is located within a county with no l�own northern long
eared bat hibernaculum. Also, under agreement with the property owner where the cleanup access points are
located, no trees will be cut. I have atta.ched a copy of the NLEB strearnlined consultation form to satisfy #he
�F(d) rule requirements.
Thank you
Trish Beam
NCDOT Division 12 Environmental Office
Email carrespondence to a�d from this sender is subj�ct to thc N.C. Public Records Law and may be disclosed to third parties.
Mdrew Henderson
US Fish & Wildlife Servite
ifi0 Zillicoa Street
Asheville, NC 286Q1
828-258-3939 ex. 227 (office}
828-258-533D (fax)
andrew endersonC�fws.00v
NOTE: This email aorrespondence and any attaahmenfs ho aad finm hhis seader arre su,bject ho tfie Freedom of Infnrma[ion �4ct (ADIAJ and may
bae disdosed to [hird partie�