20171155 Ver 1_Revised Impacts_20171012

NC SAM FIELD ASSESSMENT FORM
Accompanies User Manual Version 2.1
USACE AID #: NCDWR #:
INSTRUCTIONS:
Attach a sketch of the assessment area and photographs. Attach a copy of the USGS 7.5-minute topographic quadrangle,
and circle the location of the stream reach under evaluation. If multiple stream reaches will be evaluated on the same property, identify and
number all reaches on the attached map, and include a separate form for each reach. See the NC SAM User Manual for detailed descriptions
and explanations of requested information. Record in the ÐNotes/SketchÑ section if supplementary measurements were performed. See the
NC SAM User Manual for examples of additional measurements that may be relevant.
NOTE EVIDENCE OF STRESSORS AFFECTING THE ASSESSMENT AREA (do not need to be within the assessment area).
PROJECT/SITE INFORMATION:
1. Project name (if any):Metro South 2. Date of evaluation:7.10.17
3. Applicant/owner name:Pulte Group 4. Assessor name/organization:CWS
5. County: Mecklenburg
6. Nearest named water body
7. River basin: Catawba
on USGS 7.5-minute quad:Little Hope Creek
8. Site coordinates (decimal degrees, at lower end of assessment reach): 35.191841, -80.872336
STREAM INFORMATION: (depth and width can be approximations)
9. Site number (show on attached map):Stream A 10. Length of assessment reach evaluated (feet):168
11. Channel depth from bed (in riffle, if present) to top of bank (feet): 1-2 Unable to assess channel depth.
12. Channel width at top of bank (feet): 4 13. Is assessment reach a swamp steam? Yes No
14. Feature type: Perennial flow Intermittent flow Tidal Marsh Stream
STREAM CATEGORY INFORMATION:
15. NC SAM Zone: Mountains (M) Piedmont (P)Inner Coastal Plain (I) Outer Coastal Plain (O)
16. Estimated geomorphic
AB
skip for
19 valley shape (
Tidal Marsh Stream
): (more sinuous stream, flatter valley slope)(less sinuous stream, steeper valley slope)
(skip
17. Watershed size: Size 1 (< 0.1 mi 2) Size 2 (0.1 to < 0.5 mi 2)Size 3 (0.5 to < 5 mi 2) Size 4 (5 mi 2)
for Tidal Marsh Stream
)
ADDITIONAL INFORMATION:

18. Were regulatory considerations evaluated? Yes No If Yes, check all that apply to the assessment area.
Section 10 wate Classified Trout Waters Water Supply Watershed (I II III IV V)
r
Essential Fish Habitat Primary Nursery Area High Quality Waters/Outstanding Resource Waters
Publicly owned property NCDWR Riparian buffer rule in effect Nutrient Sensitive Waters
Anadromous fish 303(d) List CAMA Area of Environmental Concern (AEC)
Documented presence of a federal and/or state listed protected species within the assessment area.
List species:
Designated Critical Habitat (list species)
19. Are additional stream information/supplementary measurements included in ÐNotes/SketchÑ section or attached? Yes No
1. Channel Water – assessment reach metric (skip for Size 1 streams and Tidal Marsh Streams)
A Water throughout assessment reach.
B No flow, water in pools only.
C No water in assessment reach.
2. Evidence of Flow Restriction – assessment reach metric
A At least 10% of assessment reach in-stream habitat or riffle-pool sequence is severely affected by a flow restriction or fill to the
point of obstructing flow or a channel choked with aquatic macrophytes or ponded water or impoundment on flood or ebb within
the assessment reach (examples: undersized or perched culverts, causeways that constrict the channel, tidal gates, debris jams,
beaver dams).

B Not A
3. Feature Pattern – assessment reach metric
A A majority of the assessment reach has altered pattern (examples: straightening, modification above or below culvert).
B Not A
4. Feature Longitudinal Profile – assessment reach metric
A Majority of assessment reach has a substantially altered stream profile (examples: channel down-cutting, existing damming, over
widening, active aggradation, dredging, and excavation where appropriate channel profile has not reformed from any of these
disturbances).
B Not A
5. Signs of Active Instability – assessment reach metric
Consider only current instability, not past events from which the stream has currently recovered.
Examples of instability include
active bank failure, active channel down-cutting (head-cut), active widening, and artificial hardening (such as concrete, gabion, rip-rap).
A < 10% of channel unstable
B 10 to 25% of channel unstable
C > 25% of channel unstable

6. Streamside Area Interaction – streamside area metric
Consider for the Left Bank (LB) and the Right Bank (RB).

LB RB
A A Little or no evidence of conditions that adversely affect reference interaction
B B Moderate evidence of conditions (examples: berms, levees, down-cutting, aggradation, dredging) that adversely affect
reference interaction (examples: limited streamside area access, disruption of flood flows through streamside area, leaky
or intermittent bulkheads, causeways with floodplain constriction, minor ditching \[including mosquito ditching\])
C C Extensive evidence of conditions that adversely affect reference interaction (little to no floodplain/intertidal zone access
\[examples: causeways with floodplain and channel constriction, bulkheads, retaining walls, fill, stream incision, disruption
of flood flows through streamside area\] or too much floodplain/intertidal zone access \[examples: impoundments, intensive
mosquito ditching\]) or floodplain/intertidal zone unnaturally absent or assessment reach is a man-made feature on an

interstream divide
7. Water Quality Stressors – assessment reach/intertidal zone metric
Check all that apply.

A Discolored water in stream or intertidal zone (milky white, blue, unnatural water discoloration, oil sheen, stream foam)
B Excessive sedimentation (burying of stream features or intertidal zone)
C Noticeable evidence of pollutant discharges entering the assessment reach and causing a water quality problem
D Odor (not including natural sulfide odors)
E Current published or collected data indicating degraded water quality in the assessment reach. Cite source in ÐNotes/SketchÑ
section.
F Livestock with access to stream or intertidal zone
G Excessive algae in stream or intertidal zone
H Degraded marsh vegetation in the intertidal zone (removal, burning, regular mowing, destruction, etc)
I Other: (explain in ÐNotes/SketchÑ section)
J Little to no stressors
8. Recent Weather – watershed metric (skip for Tidal Marsh Streams)
For Size 1 or 2 streams, D1 drought or higher is considered a drought; for Size 3 or 4 streams, D2 drought or higher is considered a drought.
A Drought conditions and no rainfall or rainfall not exceeding 1 inch within the last 48 hours
B Drought conditions and rainfall exceeding 1 inch within the last 48 hours
C No drought conditions
9. Large or Dangerous Stream – assessment reach metric
Yes No Is stream is too large or dangerous to assess? If Yes, skip to Metric 13 (Streamside Area Ground Surface Condition).
10. Natural In-stream Habitat Types – assessment reach metric
Yes No Degraded in-stream habitat over majority of the assessment reach (examples of stressors include excessive
10a.
sedimentation, mining, excavation, in-stream hardening \[for example, rip-rap\], recent dredging, and snagging)
(evaluate for Size 4 Coastal Plain streams only, then skip to Metric 12)

Check all that occur(skip for Size 4 Coastal Plain streams)
10b. (occurs if > 5% coverage of assessment reach)
Marsh Streams
Check for Tidal
A Multiple aquatic macrophytes and aquatic mosses F 5% oysters or other natural hard bottoms
(include liverworts, lichens, and algal mats) G Submerged aquatic vegetation
Only
B Multiple sticks and/or leaf packs and/or emergent H Low-tide refugia (pools)
I Sand bottom
vegetation
C Multiple snags and logs (including lap trees) J 5% vertical bank along the marsh
D 5% undercut banks and/or root mats and/or roots K Little or no habitat
in banks extend to the normal wetted perimeter
E Little or no habitat
*********************************REMAINING QUESTIONS ARE NOT APPLICABLE FOR TIDAL MARSH STREAMS****************************
11. Bedform and Substrate – assessment reach metric (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
(skip for Coastal Plain streams)
Yes No Is assessment reach in a natural sand-bed stream?
11a.
Check the appropriate box(es).
11b. Bedform evaluated.
(evaluate 11c)
A Riffle-run section
(evaluate 11d)
B Pool-glide section

(skip to Metric 12, Aquatic Life)
C Natural bedform absent
Check
11c. In riffle sections, check all that occur below the normal wetted perimeter of the assessment reach Î whether or not submerged.
at least one box in each row(skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
. Not Present (NP) = absent, Rare
(R) = present but < 10%, Common (C) = > 10-40%, Abundant (A) = > 40-70%, Predominant (P) = > 70%. Cumulative percentages
should not exceed 100% for each assessment reach.
NP R C A P
Bedrock/saprolite
Boulder (256 Î 4096 mm)
Cobble (64 Î 256 mm)
Gravel (2 Î 64 mm)
Sand (.062 Î 2 mm)
Silt/clay (< 0.062 mm)
Detritus
Artificial (rip-rap, concrete, etc.)
skip for Size 4 Coastal Plain streams and Tidal Marsh Streams
11d. Yes No Are pools filled with sediment? ()

12. Aquatic Life – assessment reach metric (skip for Tidal Marsh Streams)
12a. Yes No Was an in-stream aquatic life assessment performed as described in the User Manual?
If No, select one of the following reasons and skip to Metric 13. No Water Other:
12b. Yes No Are aquatic organisms present in the assessment reach (look in riffles, pools, then snags)? If Yes, check all that
apply. If No, skip to Metric 13.
1 >1 Numbers over columns refer to ÐindividualsÑ for Size 1 and 2 streams and ÐtaxaÑ for Size 3 and 4 streams.
Adult frogs
Aquatic reptiles
Aquatic macrophytes and aquatic mosses (include liverworts, lichens, and algal mats)
Beetles
Caddisfly larvae (T)
Asian clam (Corbicula)
Crustacean (isopod/amphipod/crayfish/shrimp)
Damselfly and dragonfly larvae
Dipterans
Mayfly larvae (E)
Megaloptera (alderfly, fishfly, dobsonfly larvae)
Midges/mosquito larvae
)
Mosquito fish (Gambusia) or mud minnows (Umbra pygmaea
Mussels/Clams (not Corbicula)
Other fish
Salamanders/tadpoles
Snails
Stonefly larvae (P)
Tipulid larvae
Worms/leeches
13. Streamside Area Ground Surface Condition – streamside area metric (skip for Tidal Marsh Streams and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB).
Consider storage capacity with regard to both overbank flow and upland runoff.
LB RB
A A Little or no alteration to water storage capacity over a majority of the streamside area
B B Moderate alteration to water storage capacity over a majority of the streamside area
C C Severe alteration to water storage capacity over a majority of the streamside area (examples: ditches, fill, soil compaction,
livestock disturbance, buildings, man-made levees, drainage pipes)
14. Streamside Area Water Storage – streamside area metric (skip for Size 1 streams, Tidal Marsh Streams, and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB) of the streamside area.

LB RB
A A Majority of streamside area with depressions able to pond water 6 inches deep
B B Majority of streamside area with depressions able to pond water 3 to 6 inches deep
C C Majority of streamside area with depressions able to pond water < 3 inches deep
15. Wetland Presence – streamside area metric (skip for Tidal Marsh Streams)
Consider for the Left Bank (LB) and the Right Bank (RB).
Do not consider wetlands outside of the streamside area or within the normal
wetted perimeter of assessment reach.
LB RB
Y Y Are wetlands present in the streamside area?
N N
16. Baseflow Contributors – assessment reach metric (skip for Size 4 streams and Tidal Marsh Streams)
Check all contributors within the assessment reach or within view of and draining to the assessment reach.
A Streams and/or springs (jurisdictional discharges)
B Ponds (include wet detention basins; do not include sediment basins or dry detention basins)
C Obstruction passing flow during low-flow periods within the assessment area (beaver dam, leaky dam, bottom-release dam, weir)
D Evidence of bank seepage or sweating (iron in water indicates seepage)
E Stream bed or bank soil reduced (dig through deposited sediment if present)
F None of the above
17. Baseflow Detractors – assessment area metric (skip for Tidal Marsh Streams)
Check all that apply.

A Evidence of substantial water withdrawals from the assessment reach (includes areas excavated for pump installation)
B Obstruction not passing flow during low-flow periods affecting the assessment reach (ex: watertight dam, sediment deposit)
C Urban stream ( 24% impervious surface for watershed)
D Evidence that the streamside area has been modified resulting in accelerated drainage into the assessment reach
E Assessment reach relocated to valley edge
F None of the above
18. Shading – assessment reach metric (skip for Tidal Marsh Streams)
Consider aspect. Consider Ðleaf-onÑ condition.

A Stream shading is appropriate for stream category (may include gaps associated with natural processes)

B Degraded (example: scattered trees)
C Stream shading is gone or largely absent

19. Buffer Width – streamside area metric (skip for Tidal Marsh Streams)
Consider “vegetated buffer” and “wooded buffer” separately for left bank (LB) and right bank (RB) starting at the top of bank out
to the first break.

Vegetated Wooded
LB RB LB RB
A A A A 100 feet wide or extends to the edge of the watershed
B B B B From 50 to < 100 feet wide
C C C C From 30 to < 50 feet wide
D D D D From 10 to < 30 feet wide
E E E E < 10 feet wide or no trees
20. Buffer Structure – streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 (“Vegetated” Buffer Width).
LB RB
A A Mature forest
B B Non-mature woody vegetation or modified vegetation structure
C C Herbaceous vegetation with or without a strip of trees < 10 feet wide
D D Maintained shrubs
E E Little or no vegetation
21. Buffer Stressors – streamside area metric (skip for Tidal Marsh Streams)
Check all appropriate boxes for left bank (LB) and right bank (RB).
Indicate if listed stressor abuts stream (Abuts), does not abut but is
within 30 feet of stream (< 30 feet), or is between 30 to 50 feet of stream (30-50 feet).
If none of the following stressors occurs on either bank, check here and skip to Metric 22:

Abuts < 30 feet 30-50 feet
LB RB LB RB LB RB
A A A A A A Row crops
B B B B B B Maintained turf
C C C C C C Pasture (no livestock)/commercial horticulture
D D D D D D Pasture (active livestock use)
22. Stem Density – streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 (“Wooded” Buffer Width).
LB RB
A A Medium to high stem density
B B Low stem density
C C No wooded riparian buffer or predominantly herbaceous species or bare ground
23. Continuity of Vegetated Buffer – streamside area metric (skip for Tidal Marsh Streams)
Consider whether vegetated buffer is continuous along stream (parallel). Breaks are areas lacking vegetation > 10 feet wide.

LB RB
A A The total length of buffer breaks is < 25 percent.
B B The total length of buffer breaks is between 25 and 50 percent.
C C The total length of buffer breaks is > 50 percent.
24. Vegetative Composition – streamside area metric (skip for Tidal Marsh Streams)

Evaluate the dominant vegetation within 100 feet of each bank or to the edge of the watershed (whichever comes first) as it contributes to
assessment reach habitat.
LB RB
A A Vegetation is close to undisturbed in species present and their proportions. Lower strata composed of native species,
with non-native invasive species absent or sparse.
B B Vegetation indicates disturbance in terms of species diversity or proportions, but is still largely composed of native
species. This may include communities of weedy native species that develop after clear-cutting or clearing or
communities with non-native invasive species present, but not dominant, over a large portion of the expected strata or
communities missing understory but retaining canopy trees.
C C Vegetation is severely disturbed in terms of species diversity or proportions. Mature canopy is absent or communities
with non-native invasive species dominant over a large portion of expected strata or communities composed of planted
stands of non-characteristic species or communities inappropriately composed of a single species or no vegetation.
25. Conductivity – assessment reach metric (skip for all Coastal Plain streams)
25a. Yes No Was conductivity measurement recorded?
If No, select one of the following reasons. No Water Other:
25b. Check the box corresponding to the conductivity measurement (units of microsiemens per centimeter).
A < 46 B 46 to < 67 C 67 to < 79 D 79 to < 230 E 230

Notes/Sketch:
Urban Stream. Invasive species abundant.

Draft NC SAM Stream Rating Sheet
Accompanies User Manual Version 2.1

Stream Site Name Metro South Date of Assessment 7.10.17
Stream Category Pb1 Assessor Name/Organization CWS
Notes of Field Assessment Form (Y/N) YES
Presence of regulatory considerations (Y/N) NO
Additional stream information/supplementary measurements included (Y/N) YES
NC SAM feature type (perennial, intermittent, Tidal Marsh Stream) Intermittent
USACE/ NCDWR
Function Class Rating Summaryll StreamsIntermittent
A
HIGH HIGH
(1) Hydrology

MEDIUM MEDIUM
(2) Baseflow

HIGH HIGH
(2) Flood Flow

HIGH HIGH
(3) Streamside Area Attenuation

HIGH HIGH
(4) Floodplain Access

MEDIUM MEDIUM
(4) Wooded Riparian Buffer

(4) Microtopography NANA

MEDIUM MEDIUM
(3) Stream Stability

LOW LOW
(4) Channel Stability

MEDIUM MEDIUM
(4) Sediment Transport

HIGH HIGH
(4) Stream Geomorphology

(2) Stream/Intertidal Zone Interaction NANA

NANA
(2) Longitudinal Tidal Flow

NANA
(2) Tidal Marsh Stream Stability

(3) Tidal Marsh Channel Stability
NANA

NANA
(3) Tidal Marsh Stream Geomorphology
MEDIUM MEDIUM
(1) Water Quality

MEDIUM MEDIUM
(2) Baseflow

MEDIUM MEDIUM
(2) Streamside Area Vegetation

MEDIUM MEDIUM
(3) Upland Pollutant Filtration

HIGH HIGH
(3) Thermoregulation

YES YES
(2) Indicators of Stressors
HIGH NA
(2) Aquatic Life Tolerance

(2) Intertidal Zone Filtration
NANA
LOW LOW
(1) Habitat

LOW LOW
(2) In-stream Habitat

MEDIUM MEDIUM
(3) Baseflow

MEDIUM MEDIUM
(3) Substrate

LOW LOW
(3) Stream Stability

LOW LOW
(3) In-stream Habitat

MEDIUM MEDIUM
(2) Stream-side Habitat

LOW LOW
(3) Stream-side Habitat
HIGH HIGH
(3) Thermoregulation

(2) Tidal Marsh In-stream Habitat
NANA

NANA
(3) Flow Restriction

NANA
(3) Tidal Marsh Stream Stability

(4) Tidal Marsh Channel Stability
NANA

NANA
(4) Tidal Marsh Stream Geomorphology

(3) Tidal Marsh In-stream Habitat
NANA

(2) Intertidal Zone
NANA
MEDIUM MEDIUM
Overall

NC Engineering Firm License # C-0658
CITY OF CHARLOTTE, NORTH CAROLINA
CULVERT PLAN AND PROFILE
METRO SOUTH
S1:
PermanentImpact
-58lf(culvert)
-Permanentlossofwaters
-Mitigationproposedat1:1ratio
S3:
PermanentImpact
-15lf(gradingandconcrete
turndown)
S2:
PermanentImpact
-26lf(riprap)
-Nolossofwaters
REVISIONS:
1017170
JULY 14, 2017
AMM
RAK
AMM
Figure 1" = 10'C5.10
DESIGNED BY:
CHECKED BY:
DRAWN BY:
NLD
PROJECT #:
SHEET #:
Q.C. BY:
SCALE:
DATE:
9
5'5'10'20'

Office Use Only:
Corps action ID no.
SAW-2017-01950
DWQ project no.
Form Version 1.4 January 2009
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the Corps:
Section 404 Permit Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 29 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps?
Yes No
1d. 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
For the record only for Corps Permit:
1e. Is this notification solely for the record For the record only for DWQ
because written approval is not required? 401 Certification:
Yes No
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
Yes No
fee program.
1g. Is the project located in any of NC’s twenty coastal counties. If yes, answer 1h
Yes
below.
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
Yes No
2. Project Information
Metro South
2a. Name of project:
Mecklenburg
2b. County:
Charlotte
2c. Nearest municipality / town:
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
Crosland Greens LLC
23287-544
3b. Deed Book and Page No.
Sandra Binder
3c. Responsible Party (for LLC if
applicable):
POBox3151
3d. Street address:
MilwaukeeWI53201
3e. City, state, zip:
7702253441
3f. Telephone no.:
N/A
3g. Fax no.:
[e-mail]
3h. Email address:
Page 1 of 16
PCN Form – Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is:
Agent Other, specify: Client
Mr.CiscoGarcia
4b. Name:
PulteHomeCompany,LLC
4c. Business name
(if applicable):
11121CarmelCommonsBlvd.Suite450
4d. Street address:
Charlotte,NC28226
4e. City, state, zip:
(704)5434922
4f. Telephone no.:
N/A
4g. Fax no.:
[e-mail]
4h. Email address:
5. Agent/Consultant Information (if applicable)
GreggAntemann,PWS
5a. Name:
CarolinaWetlandServices,Inc.
5b. Business name
(if applicable):
550E.WestinghouseBlvd.
5c. Street address:
Charlotte,NC28273
5d. City, state, zip:
7044081683
5e. Telephone no.:
N/A
5f. Fax no.:
[e-mail]
5g. Email address:
Page 2 of 16
PCN Form – Version 1.4 January 2009

B. Project Information and Prior Project History
1. Property Identification
149-05-304, 149-05-444, 149-05-443, 149-05-442, 149-05-
1a. Property identification no. (tax PIN or parcel ID):
441, 149-05-440, 149-05-439, 149-05-438, 149-05-437,
149-05-436, 149-05-435, 149-05-111, 149-05-112, 149-05-
113, 149-05-114, 149-05-211, 149-05-201, 149-05-202,
149-05-203, 149-05-204, 149-05-205, 149-05-206, 149-05-
207, 149-05-208, 149-05-209, 149-05-210, 149-08-602
1b. Site coordinates (in decimal degrees): Latitude: 35.192205° Longitude: -80.870861°
1c. Property size: 13.6 acres
2. Surface Waters
LittleHopeCreek
2a. Name of nearest body of water to proposed project:
ClassC
2b. Water Quality Classification of nearest receiving water:
Catawba(HUC03050103)
2c. River basin:
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:
The project area consists of single and multi-family residences with maintained lawns and a powerline right-of-way (Figure 3,
attached). The surrounded areas consist of single family residential areas and commercial properties. Typical on-site
Quercus phellosLiquidambar styracifluaPinus
vegetation within the project area include willow oak (), sweetgum (), Virginia pine (
virginianaQuercus rubraLigustrum sinenseUlmus alata
), northern red oak (), Chinese privet (), winged elm (), eastern redcedar
Juniperus virginianaVitis rotundifoliaSmilax rotundifoliaHedera helix
(), muscadine (), greenbrier (), and English ivy (). The
Solidago altissimaRubus argutus
powerline right-of-way is dominated with species such as tall goldenrod (), blackberry (), and
Ampelopsis brevipedunculata
porcelain berry ().
3b. List the total estimated acreage of all existing wetlands on the property: 0 acre of jurisdictional wetland area
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 313 linear feet of
perennial stream, 231 linear feet of intermittent stream.
3d. Explain the purpose of the proposed project:
The purpose of the project is to redevelop the property into a multi-family apartment complex. This project will help meet the
increasing demand for housing in an area of Charlotte which is expanding due to the proximity to the light trail and uptown.
Impacts to on-site jurisdictional waters are proposed in order to provide access to the proposed development.
3e. Describe the overall project in detail, including the type of equipment to be used: (see next page)
Page 3 of 16
PCN Form – Version 1.4 January 2009

3e.
Redeveloping the property into a multi-family apartment complex will result in unavoidable impacts to jurisdictional stream
channel (Stream A). Impacts to Stream A are the result of the construction of one road crossing in order to provide sufficient
ingress and egress for traffic and emergency vehicles throughout the development. The proposed culvert installation will result
in 58-linear feet loss of jurisdictional waters. The proposed rip rap apron downstream of the culvert will result in an additional
26 linear feet of permanent impact but no loss of jurisdictional waters. Grading upstream of the proposed culvert and concrete
turndown for the inlet protection will result in an additional 15 linear feet of permanent stream impacts. The culvert design will
maintain the upstream/downstream hydrologic connection and the aquatic life passage of Stream A with the culvert bottom
being buried below streambed elevation. Figure 9 depicts the proposed plan and profile view of the proposed road crossing.
Stream Impacts (S1-S3) – Stream A
The proposed road crossing is located in the southeastern portion of the property. Culvert installation and riprap apron
placement associated with the road crossing construction will result in 84 linear feet of permanent impacts to Stream A (Figures
8 and 9, attached). To construct the proposed road crossing, a 46-linear foot, 8-foot by 4-foot reinforced box culvert will be
installed, resulting in 58 linear feet of permanent impacts to Stream A (S1). The proposed culvert will be buried a minimum of
one foot below the channel bed to allow passage of aquatic life and maintain low flows. Headwalls at the inlet and outlet of the
culvert will be utilized in order to minimize channel impacts to the maximum extent practicable.
Placement of a riprap apron at the culvert outlet will result in an additional 26 linear feet of permanent impact (S2). Grading
upstream of the proposed culvert and concrete turndown for the inlet protection will have 15 linear feet of additional impacts to
Stream A (S3). The placement of riprap is necessary to prevent erosional forces from undermining the culvert inlets and
outlets, as well as maintain the integrity of the road crossing. A plan view and profile view of the proposed culvert are attached
as Figure 9.
On September 15th, Mr. Alan Johnson provided comments through email regarding the culvert design. Per his comments, the
culvert diagram now shows sills at the inlet and outlet. Culvert profile also now indicates that the culvert will be backfilled.
Additionally, upon installation the stream bed, immediately above and below the inlet outlet will be brought back to original
stream elevation.
Typical construction equipment such as tract hoe will be used.
Page 4 of 16
PCN Form – Version 1.4 January 2009

4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Yes No Unknown
Corps or State been requested or obtained for this property /
Comments:
project (including all prior phases) in the past?
4b. If the Corps made the jurisdictional determination, what type
Preliminary Final
of determination was made?
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.
5. Project History
5a. 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 5 of 16
PCN Form – Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1a. 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. Area
Wetlandimpact Type of impact Type of wetland ForestedType of jurisdiction of
numberCorps (404,10) or impact
Permanent (P) orDWQ (401, other) (acres)
Temporary(T)
W1
W2
W3
W4
W5
W6
Total Wetland Impacts:
2g.
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.
3g.
3a.3b.3c.3d.3e.3f.
Impact
Average
Type of impact Stream name
StreamimpactPerennial (PER) or Type of
length
numberintermittent (INT)? jurisdiction stream
(linear
Permanent (P) orwidth
feet)
Temporary(T)
(feet)
CulverStreamAINTCorps458
S1 P
RiprapStreamAINTCorps426
S2 P
GradingandconcreteStreamAINTCorps415
S3 T
turndown
S4
99lf
Total stream and tributary impacts
3h.
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3i. Comments: Impacts to streams total 99 linear feet. Total loss of jurisdictional waters of the U.S. is 58 linear feet.
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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.
Openwater Name of waterbody
impactnumber (ifapplicableType of impact WaterbodyArea of impact (acres)
type
Permanent (P) or
Temporary(T)
ChooseOneChoose
O1
ChooseOneChoose
O2
ChooseOneChoose
O3
ChooseOneChoose
O4
Total open water impacts
4f.
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.5b.5c.5d.5e.
Proposed use or
numberWetland Impacts (acres) Stream Impacts (feet)
Pond ID Upland
purpose of pond
(acres)
Flooded Filled Excavated Flooded Filled Excavated
ChooseOne
P1
ChooseOne
P2
Total:
5f.
5g. Comments:
5h. Is a dam high hazard permit required?
Yes No If yes, permit ID no:
5i. 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
MUST
below. If any impacts require mitigation, then you fill out Section D of this form.
.
6aProject is in which protected basin? Neuse Tar-Pamlico Catawba Randleman Other:
6b.6c.6d.6e.6f.6g.
BufferImpact Reason for impact StreamnameBufferZone1Zone2
number–mitigationimpactimpact
Permanent (P) orrequired?(square(square
Temporary(T)feet)feet)
Yes/No
B1
Yes/No
B2
Yes/No
B3
Yes/No
B4
Yes/No
B5
Yes/No
B6
Total Buffer Impacts:
6h.
6i. Comments:
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PCN Form – Version 1.4 January 2009

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
In order to avoid and minimize the impacts to the jurisdictional waters of the U.S., the Metro South site was delineated prior to
developing the site plan and the proposed site plan was designed around the delineation results. Proper sediment and erosion
control measures will be used to minimize disturbances to downstream waters. Construction activities and impacts to on-site
jurisdictional waters of the U.S. will comply with all conditions of Nationwide Permit 29 and Water Quality Certificate No. 4092.
No Build Alternative
In an attempt to minimize impacts to jurisdictional waters while meeting the goals of the project, a “No Build” alternative was
considered. The property is being purchased for the purpose of providing more residential housing to meet the growth and
demand of an area in Charlotte experiencing significant population growth. A “No Build” option would not meet the project goals
of providing necessary housing to meet the current demand. Therefore, the No Build Alternative was eliminated from further
consideration.
The connection from Weona Avenue to Hollis Road is being required through the City of Charlotte's rezoning conditions. In
order to make this connection, the stream must be crossed. The proposed roadway corridor is restricted by the property line and
the existing end of Weona Avenue where the connection must occur to meet the rezoning conditions. With the existing end of
Weona Avenue’s close proximity to the stream, it is not possible to divert the proposed roadway around the stream and still meet
roadway design criteria.
Headwalls 7’ in height on upstream and downstream side will be utilized to minimize impacts. Additionally, the elevation of the
road was lowered to further reduce the footprint of the crossing.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Proper sediment and erosion control measures will be used to minimize disturbances to downstream waters. Construction
activities and impacts to on-site jurisdictional waters of the U.S. will comply with all conditions of Nationwide Permits 29 and
Water Quality Certificate No. 4092.
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PCN Form – Version 1.4 January 2009

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?
2b. If yes, mitigation is required by (check all that apply):
DWQ Corps
Mitigation bank
2c. If yes, which mitigation option will be used for this
Payment to in-lieu fee program
project?
Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
ChooseOne
Quantity:
Type:
3b. Credits Purchased (attach receipt and letter) Quantity:
ChooseOne
Type:
Quantity:
ChooseOne
Type:
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: 58
Stream
4c. If using stream mitigation, stream temperature:
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.
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.
Reason for impact Total impact MultiplierRequiredmitigation
Zone
(square feet) (squarefeet)
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PCN Form – Version 1.4 January 2009

3 (2 for Catawba)
Zone 1
1.5
Zone 2
Total buffer mitigation required:
6f.
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:
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PCN Form – Version 1.4 January 2009

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?
1b. If yes, then is a diffuse flow plan included? If no, explain why.
Yes No
This project is associated with a stormwater infrastructure maintenance project and
does not require a SMP.
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
>24 %
2b. Does this project require a Stormwater Management Plan?
Yes No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
The plan is currently being reviewed by the City of Charlotte.
2e. Who will be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a. In which local government’s jurisdiction is this project?
Phase II
NSW
3b. Which of the following locally-implemented stormwater management programs
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
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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
Yes No
use of public (federal/state) land?
1b. 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)?
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
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 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 will not result in additional future development.
4. Sewage Disposal (DWQ Requirement)
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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.
The proposed sewers will tie into the exiting sewer infrastructure off site at the northeast corner of the property.
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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?
Asheville
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?
CWS scientists performed a data review using North Carolina Natural Heritage Program (NCNHP) Data Explorer on July
12, 2017 to determine the presence of any federally-listed, endangered species, threatened species, or critical habitat
located within the project area. Based on the NCNHP review, there are no records of federally-protected species within the
project limits or within a mile of the project area. A copy of the NCNHP report is attached (Attachment I).
The United States Fish and Wildlife Service’s (USFWS) Records of Endangered, Threatened, and Species of Concern list
for Mecklenburg County was reviewed. The USFWS database lists the Schweinitz’s sunflower (Helianthus schweinitzii),
Michaux’s sumac (Rhus michauxii), smooth purple coneflower (Echinacea laevigata), Carolina heelsplitter (Lasmigona
decorata), rusty-patched bumble bee (Bombus affinis), and bald eagle (Haliaeetus leucocephalus) as potentially occurring
in Mecklenburg County (Table 1, next page). Additionally, the project area is within northern long-eared bat (Myotis
septentrionalis) range.
Prior to the field work, CWS scientists visited a known population of Helianthus schweinitzii on July 10, 2017 to determine
the condition of its stem, leaves, and flowers. Based on the site visit, the aboveground plant parts are identifiable but
flowers were present. On July 10, 2017, CWS scientists conducted a pedestrian survey of the project area for federally-
protected species. Transects were completed within identified areas of supportive habitat, as applicable, for potentially
occurring federally-protected species.
Potential habitat was observed for the rusty-patched bumble bee but no individuals were identified within the project limits.
Therefore, the proposed project May Affect, is Not Likely to Adversely Affect the rusty patched bumble bee. However, the
USFWS is currently considering all occurrences of rusty-patched bumble bee to be historic and are not requiring surveys at
this time. Based on the literature search and the results of the on-site assessment for Schweinitz's sunflower, Michaux's
sumac, Smooth purple coneflower, Carolina heelsplitter, Bald Eagle, it has been determined that no habitat was observed
for the aforementioned federally protected species. Therefore, this project will have no effect on these species.
Additionally, any incidental take on NLEB that may result from associated activities is exempt under the 4(d) rule.
A letter requesting concurrence was sent to the USFWS on July 17, 2017. In their response letter, the USFWS concurred
with CWS findings (Attachment J).
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?
NOAA Fisheries: http://www.habitat.noaa.gov/protection/efh/habitatmapper.html
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)?
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7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
A letter was forwarded to the North Carolina State Historic Preservation Office (SHPO) on June, 2015 to determine the
presence of any areas of architectural, historic, or archaeological significance that would be affected by the project. CWS
also consulted the SHPO online GIS service and found no historical structures, buildings, sites, or districts within the project
limits. In a response letter, dated June 29, 2015, SHPO stated that they are “aware of no historic resources which would be
affected by the project” (Attachment H).
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:
There will be no fill in the FEMA floodplain. Additionally, the extents of grading will be outside of the FEMA floodplain.
8c. What source(s) did you use to make the floodplain determination? FEMA FIRM No. 3710454300L
10.12.17
Mr.GreggAntemann
Applicant/Agent's Signature
(Agent's
Date
signature is valid only if an authorization letter
Applicant/Agent's Printed Name
provided.)
from the applicant is
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PCN Form – Version 1.4 January 2009