20180936 Ver 1_401 Application_20180718

Action History (UTC -05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/5/2018 10:44:49 AM (Start Event)
Accept by Montalvo, Sheri A 7/9/2018 10:09:13 AM (Non DOT Initial Review)
The task was assigned to Montalvo, Sheri A. The due date is: July 10, 2018 5:00 PM
7/5/2018 10:47 AM

DWR
Division of water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
January 31, 2018 Ver 2.3
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all mandatory questions are answered.
Also, if at any point you wish to print a copy of the E -PCN, all you need to do is right -click on the document and you can print a copy of the form.
Below is a link to the online help file.
https://edocs.deq.nc.govMaterResources/0/edocl6247041PCN%20Help%20File%202018-1-30.pdf
A. Processing Information
County (or Counties) where the project is located:*
Union
Is this project a public transportation project?*
f Yes f• No
This is any publicly funded by nunicipal,state or federal funds road, rail, airport transportation project.
1a. Type (s) of approval sought from the Corps:*
V Section 404 Permit (wetlands, streams and waters, Clean Water Act)
F Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
IJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
This form may be Corps to initiate the standard/individual permit process. Please contact your Corps representative for submittal of standard permits.
All required items that are not provided in the E -PCN and be added to the miscellaneous upload located at the bottom of this form.
Nationwide Permit (NWP) Number: 12 - Utility Lines
NWP Number Other:
List all IWV nurrbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
IJ 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
F Non -404 Jurisdictional General Permit r Riparian Buffer Authorization
r Individual Permit
*
1d. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
O Yes O No
For the record only for Corps Permit: O Yes O No

1e. 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
f Yes C No
1f. Is the project located in anyof NC's twentycoastal counties?*
r Yes r No
1h. Is the project located in a designated trout watershed?*
f Yes f• No
Link to trout information: http://vmw.saw.usace.army.mil/Missions/Regulatory-Permit-ProgranVAgency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Linda Diebolt
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
(XXX)XXX-XXXX
[phone]
1d. Who is applying for the permit?
❑ Owner rJ Applicant (other than owner) rJ Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
N/A - Utility easement
2b. Deed book and page no.:
N/A
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
Address Line 2
City
Fbstal / Zip Code
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(XXX)XXX-XXXX
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
f Agent
r Other Municipality
If other please specify.
3b. Name:
State / Province / Fbgion
Country

John Shutak
3c. Business Name:
(if applicable)
Union County Public Works Department
3d. Address
Street Address
500 North Main Street
Address Line 2
Suite 600
C]ty
State/ Province/ Fbgion
Monroe
NC
Fbstal / Zip Code
Country
28112
US
3e. Telephone Number:
[phone]
(XXX)XXX-XXXX
Fax Number:
(XXX)XXX-)O=
3g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Linda Diebolt
4b. Business Name:
ff applicable)
Hazen and Sawyer
4c. Address
Street Address
4011 WestChase Boulevard
Address Line 2
Suite 500
Oty
State / Province / Fbgion
Raleigh
NC
Fbstal / Zip (ode
Country
27607
US
4d. Telephone Number:
[phone]
(XXX)XXX-XXXX Fax Number:
(XXX)xxx-:ooa
0. Email Address:*
[e-mail]
Agent Authorization Letter*
Pease provide the Agent Authorization Letter if you are subn itting this docurrent.
PCN -Agent Authorization Form.pdf 1.17MB
FILE TYPE A-STBEPDF
C. Project Information and Prior Project History

1. Project Information
1a. Name of project:*
West Fork Twelve -Mile Creek Interceptor
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
*
Weddington
1d. Driving directions*
If it is a new project and can not easily be found in a GPS napping system Please provide directions.
Take 1-485 to Providence and exit onto Providence Road (SR 16) south to Weddington. Turn left onto Weddington Road and then turn left
onto Waxhaw-Indian Trail Road. Take a left onto Beulah Church Road. The central portion of the project corridor is located on the south
side of Beulah Church Road at the intersection with Cobblecreek Drive.
2. Project Identification
2a. Property Identification Number:
(tax PIN or parcel ID)
Numerous: See attached design drawings: Drawing X1
2b. Property size:
(in acres)
36.9
2c. Project Address
Street Address
N/A
Address Line 2
Qty
State / Province / Fbgion
NC
Fbstal / Zip Code
Country
us
2d. Site coordinates in decimal degrees
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey -grade GPS device) after the decimal place as
appropriate, based on how the location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude:* Longitude:*
35.027028 -80.706443
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest bodyof water to proposed project:*
West Fork Twelve -Mile Creek
3b. Water Resources Classification of nearest receiving water:*
C
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Catawba

River Basin Lookup
4. Project Description
4a. 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 consists of a mainly undeveloped, wooded corridor that traverses several maintained areas consisting
of roadside easements, residential lawns, public areas and power easements; agricultural fields; and roadways.
Land use in the vicinity of the project consists of rural residential areas, undeveloped land, and farmland.
4b. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
click the upload button or drag and drop files here to attach docurrent
USGS Topographic Map.pdf
File type mist be pdf
2.78MB
4c. Attach an 8 1/2X11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
click the upload button or drag and drop files here to attach docurrent
NRCS Soils.pdf 332.52KB
File type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0.166
4e. List the total estimated linear feet of all existing streams on the property:
(intermittent and perennial)
763
4f. Explain the purpose of the proposed project:*
The purpose of the project is to install a new gravity sewer to serve existing and future residential developments
within the west -central portion of the Union County Public Works Department's Twelve -Mile Creek service area.
Construction of the newgravity sewer will allowfor the decommissioning and demolition of three existing pump
stations, including Brookhaven Pump Station, Scotch Meadows Pump Station, and Grace Meadows Pump Station.
The project will allow Union County to meet the increasing wastewater demands in the service area.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Approximately 4.8 miles of gravity sewer line will be installed along West Fork Twelve -Mile Creek using open cut
techniques. A majority of the new gravity sewer line will be installed within wooded, undeveloped areas. West Fork
Twelve -Mile Creek will be traversed eleven times and three unnamed tributaries to West Fork Twelve -Mile Creek
will be crossed once each by the pipe. Additionally, portions of six wetlands will be traversed by the wastewater
line. Crossing of the streams and wetlands by the pipe will not result in loss of jurisdictional waters of the U.S.;
however, conversion of forested wetlands to non -forested wetlands will occur in a small portion of two wetlands.
All stream crossings will be performed within 15 degrees of perpendicular and all stream work will be performed in
the dry. During construction activities, temporary stone dams will be placed upstream and downstream of the area
of disturbance, and the stream will be pumped around the dammed area. Fords will be installed at eight of the
fifteen (15) stream crossings during construction. The fords will be permanent, as required to maintain accessibility
to the wastewater transmission line for emergency and maintenance activities. The remaining seven stream
crossings will be accomplished with temporary bridges.
Installation of the permanent fords will consist of excavation of the area in which the ford will be installed with
temporary sidecasting of the stream sediments. Articulated open -cell blocks or rip rap will be placed within the
excavated area to a level that is approximately 6 inches below the existing bed of the stream. Final selection of the
material will be made by the contractor. Excavated streambed material will be placed over the articulated open -cell
blocks or rip rap to the elevation of the pre -construction streambed.
Indirect impacts of the project are anticipated to be beneficial. Construction of the project will allowfor new and
existing construction to discharge to municipal sewer versus individual septic systems or conveyed via pump
stations. Equipment anticipated to be used during the proposed gravity sewer line installation include backhoes,
front-end loaders, dump trucks, and cranes. Details of proposed activities, such as temporary stream bypass, anti -
seep collars, temporary bridges, and permanent fords, are provided on the design drawings submitted in
conjunction with this permit application.
4h. Please upload project drawings for the proposed project.
click the upload button or drag and drop files here to attach docurrent
WEST FORK 12 -MILE 07-01-2018.pdf 29.93MB
File type mast be pdf
5. Jurisdictional Determinations

5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No r Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?
r Preliminary r Approved r Unknown
Corps AID Number:
Exarrple: SAW -2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Linda Diebolt
r N/A
Hazen and Sawyer
Keven Arrance / Hazen and Sawyer
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d1. Jurisdictional determination upload
Click the upload button or drag and drop files here to attach docurrent
File type mist be RF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
7. Future Project Plans
7a. Is this a phased project?*
f Yes r No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the
proposed project or related activity? This includes other separate and distant crossing for linear projects that require Department of the
Army authorization but don't require pre -construction notification.
No.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
V Wetlands V Streams -tributaries r Buffers
r- 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. Site # - Reason for impact* 2b. Impact type * 2c. Type of wetland * 2d. Wetland name *2e. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Pipe Wetland Crossing 1 T NON-NCWAM TYPES W-1 No Both 0.012
Ivbp label (e.g. Road Grossing 1 - Qilvert, Fern -anent (Pt or (404, 10) or DAR (401, (acres)
dewatering, etc) Temporary (T) other)

Pipe Wetland Crossing 2
T
NON-NCWAM TYPES
W -2A
No
Both
0.024
[Vbp label (e.g. Road Crossing 1 - CLlvert,
Fernanent (F� or
type*
(404, 10) or DAR (401,
(acres)
dewatering, etc)
Terrporary (T)
S1
Pipe Crossing 1 - S-1
T
other)
West Fork Twelve-
Pipe Wetland Crossing 3
T
NON-NCWAM TYPES
W-213
No
Both
0.007
Ivbp label (e.g. Road Crossing 1 - Calvert,
Fern -anent (P) or
Perennial (FES or
Average
(404, 10) or DAR (401,
(acres)
dewatering, etc)
Temporary (T)
intermittent (INT)
other)
(feet)
Pipe Wetland Crossing 4
T
Bottomland Hardwood
W-5
Yes
Both
0.013
Ivbp label (e.g. Fuad Crossing 1 - Calvert,
Fern"anent (P) or
Forest
S-2
(404, 10) or DAR (401,
(acres)
dewatering, etc)
Temporary (T)
Average
(linear feet) 2
other)
Iv13p label (e.g. Fbad Crossing
Pipe Wetland Crossing 4 -
P
Bottomland Hardwood
W-5
Yes
Both
0.029
Conversion
Ferrrenent(P)or
Forest
(404, 10) orDhR(401,
(acres)
Map label (e.g. Road Crossing 1 - Calvert,
Temporary (T)
S3
Pipe Crossing 2 - S-2
T
other)
West Fork Twelve-
dewatering, etc)
Both
15
37 5
Map label (e.g. Fbad Crossing
Permanent (F') or
Pipe Wetland Crossing 5
T
Bottomland Hardwood
W-7
Yes
Both
0.018
K/bp label (e.g. Fuad Crossing 1 - Calvert,
Ferrranent (P) or
Forest
intermttent (INT)
(404, 10) or DhR(401,
(acres)
dewatering, etc)
Temporary (T)
Pipe Crossing 3 - S-3
T
Excavation
other)
Perennial
Pipe Wetland Crossing 5 -
P
Bottomland Hardwood
W-7
Yes
Both
0.059
Conversion
Ferrranent(P)or
Forest
Average
(linear feet) 0
(404, 10) orDAR (401,
(acres)
K/ap label (e.g. Road Crossing 1 - Calvert,
Temporary (T)
intermittent (INT)
other)
0
dewatering, etc)
Pipe Crossing 4 - S-4
T
Excavation
West Fork Twelve-
Perennial
Both
Pipe Wetland Crossing 6
T
NON-NCWAM TYPES
W-8
Yes
Both
0.004
Ivbp label (e.g. Road Crossing 1 - Calvert,
Ferrranent (P) or
Average
(linear feet) 5
(404, 10) or DhR(401,
(acres)
dewatering, etc)
Temporary (T)
intermittent (INT)
(feet)
other)
2g. Total Temporary Wetland Impact
0.078
2g. Total Permanent Wetland Impact
0.088
2g. Total Wetland Impact
0.166
2h. Comments:
Impacts to W-3, W-4, and W-6 were avoided during the design phase of the project.
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. Reason for impact*3b.lmpact
3c. Type of impact*3d.
Stream name*
3e. Stream
3f. Type of
3g. Stream 3h. Impact s
type*
Type*
Jurisdiction*
width*
length*
S1
Pipe Crossing 1 - S-1
T
Excavation
West Fork Twelve-
Perennial
Both
15
50 7
K/hp label (e.g. Road Crossing
Fernanent (P) or
Mile Creek
Perennial (FES or
Average
(linear feet) 5
1)
Tenporary (T)
intermittent (INT)
(feet)
0
S2
Permanent Ford 1 -
T
Rip Rap Fill
West Fork Twelve-
Perennial
Both
15
15 2
S-2
Permanent (P)or
Mile Creek
Perennial (FEP�or
Average
(linear feet) 2
Iv13p label (e.g. Fbad Crossing
Temporary (T)
intermttent (INT)
(feet)
5
1)
S3
Pipe Crossing 2 - S-2
T
Excavation
West Fork Twelve-
Perennial
Both
15
37 5
Map label (e.g. Fbad Crossing
Permanent (F') or
Mile Creek
Perennial (F$?) or
Average
(linear feet) 5
1)
Temporary (T)
intermttent (INT)
(feet)
5
S4
Pipe Crossing 3 - S-3
T
Excavation
West Fork Twelve-
Perennial
Both
18
50 9
Map label (e.g. Road Crossing
Permanent (F) or
Mile Creek
Perennial (FBS or
Average
(linear feet) 0
1)
Tenporary (T)
intermittent (INT)
(feet)
0
S5
Pipe Crossing 4 - S-4
T
Excavation
West Fork Twelve-
Perennial
Both
18
53 9
Map label (e.g. Road Crossing
Ferrranent (P) or
Mile Creek
Perennial (FEP� or
Average
(linear feet) 5
1)
Temporary (T)
intermittent (INT)
(feet)
A

S6
Permanent Ford 2 -
T
Rip Rap Fill
West Fork Twelve-
Perennial
Both
13
15
Ferrranent(Pjor
S-5
Permanent (P)or
Perennial (Fff�or
Mile Creek
Perennial (PEP�or
(linear feet)
Average
(linear feet) !
Nep label (e.g. Road Crossing
Temporary (T)
(feet)
intermittent (INT)
1)
(feet)
1)
S14 Pipe Crossing 9 - S-9
T
Excavation
West Fork Twelve-
S7
Pipe Crossing 5 - S-5
T
Excavation
West Fork Twelve-
Perennial
Both
13
35
Nep label (e.g. Road Crossing
Permanent (P) or
1)
Mile Creek
Perennial (Ft3� or
Average
(linear feet)
(feet)
1)
Temporary (T)
T
Excavation
intermittent (INT)
Perennial
(feet)
15
S8
Permanent Ford 3 -
T
Rip Rap Fill
West Fork Twelve-
Perennial
Both
26
15
Nbp label (e.g. P bad Grossing
S-6
Permanent (P)or
Mile Creek
Perennial (FBP)or
(feet)
Average
(linear feet) !
Nbp label (e.g. Fbad Crossing
Temporary (T)
intermittent (INT)
(feet)
T
Rip Rap Fill
1)
Perennial
Both
16
15
S-11
Permanent (P) or
S9
Pipe Crossing 6 - S-6
T
Excavation
West Fork Twelve-
Perennial
Both
26
35
intermittent (INT)
Nbp label (e.g. Road Crossing
Permanent (P) or
Mile Creek
Perennial (F9F� or
Average
(linear feet)
1)
Temporary (T)
S17 Pipe Crossing 11 - S-
T
intermittent (INT)
West Fork Twelve-
(feet)
Both
S10
Permanent Ford 4-
T
Rip Rap Fill
West Fork Twelve-
Perennial
Both
21
15
(linear feet)
S-7
Permanent (F' or
Mile Creek
Perennial (PHP�or
Average
(linear feet)
1)
Nep label (e.g. P oad Crossing
Temporary (T)
intermittent (INT)
(feet)
S18 Permanent Ford 7 -
T
1)
West Fork Twelve-
Perennial
Both
16
15
S-12
Permanent (P)or
S11
Pipe Crossing 7-S-7
T
Excavation
West Fork Twelve-
Perennial
Both
21
35
Ift label (e.g. Fbad Crossing
Permanent (P) or
(feet)
Mile Creek
Perennial (PB:?) or
Average
(linear feet) ,
1)
Temporary (T)
S19 Pipe Crossing 12 - S-
intermittent (INT)
Excavation
(feet)
Perennial
S12
Pipe Crossing 8 - S-8
T
Excavation
West Fork Twelve-
Perennial
Both
25
50
Average
Nep label (e.g. Fbad Grossing
Permanent (P) or
Temporary (T)
Mile Creek
Perennial (Ft3� or
intermittent (INT)
Average
(linear feet)
1)
Temporary (1 )
intermittent (INT)
(feet)
S13 Permanent Ford 5-
T
Rip Rap Fill
West Fork Twelve-
Perennial
Both
16
15
S-9
Ferrranent(Pjor
Mile Creek
Perennial (Fff�or
Average
(linear feet)
Nep label (e.g. Fbad Grossing
Temporary (T)
intermittent (INT)
(feet)
1)
S14 Pipe Crossing 9 - S-9
T
Excavation
West Fork Twelve-
Perennial
Both
16
35
Nep label (e.g. Road Grossing
Ferrrenent (P) or
Mile Creek
Perennial (F$� or
Average
(linear feet)
1)
Temporary (T)
intermittent (INT)
(feet)
S15 Pipe Crossing 10 - S-
T
Excavation
West Fork Twelve-
Perennial
Both
15
50
10
Ferrrenent (P) or
Mile Creek
Perennial (FBS or
Average
(linear feet)
Nbp label (e.g. P bad Grossing
Temporary (T)
intermittent (IM)
(feet)
1)
S16 Permanent Ford 6 -
T
Rip Rap Fill
West Fork Twelve-
Perennial
Both
16
15
S-11
Permanent (P) or
Mile Creek
Perennial (FT3� or
Average
(linear feet)
Nbp label (e.g. Pdbad Crossing
Temporary (T)
intermittent (INT)
(feet)
1)
S17 Pipe Crossing 11 - S-
T
Excavation
West Fork Twelve-
Perennial
Both
16
35
11
Permanent (P) or
Mile Creek
Perennial (P$P� or
Average
(linear feet)
Nep label (e.g. Road Crossing
Tenporary (T)
intermittent (INT)
(feet)
1)
S18 Permanent Ford 7 -
T
Rip Rap Fill
West Fork Twelve-
Perennial
Both
16
15
S-12
Permanent (P)or
Mile Creek
Perennial (PEF�or
Average
(linear feet)
Nep label (e.g. P oad Crossing
Temporary (T)
internittent (INT)
(feet)
1)
S19 Pipe Crossing 12 - S-
T
Excavation
West Fork Twelve-
Perennial
Both
16
35
12
Permanent (P) or
Mile Creek
Perennial (FES or
Average
(linear feet)
Nep label (e.g. P oad Crossing
Temporary (T)
intermittent (INT)
(feet)
1)
S20 Pipe Crossing 13 - S-
T
Excavation
UT to West Fork
Intermittent
Both
6
58
13
Ferrrenent(P)or
Twelve -Mile Creek
Perennial (F3:?)or
Average
(linear feet)
Nep label (e.g. Poad Grossing
Temporary (l)
intermittent (INT)
(feet)
1)
S21 Pipe Crossing 14 - S-
T
Excavation
UT to West Fork
Intermittent
Both
3
50
14
Perrranent(PT)or
Twelve -Mile Creek
Perennial (Fff�or
Average
(linear feet)
Peep label (e.g. Pdoad Grossing
Temporary (T)
intermittent (INT)
(feet)
1)

S22 Permanent Ford 8 -
T Rip Rap Fill
UT to West Fork
Intermittent Both
6
15
S-15
Permanent (Pfor
Twelve -Mile Creek
Perennial(PER)or
Average
(linear feet)
Ivbp label (e.g. Road Crossing
Temporary (T)
intermittent (INT)
(feet)
1)
S23 Pipe Crossing 15 - S-
T Excavation
UT to West Fork
Intermittent Both
6
35
15
Permanent (P)or
Twelve -Mile Creek
Perennial (PER or
Average
(linear feet)
Ift label (e.g. Road Crossing
Temporary (T)
intermittent (INT)
(feet)
1)
** All Perennial or Intermittent streams must be verified by DWR
or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
0
3i. Total temporary stream impacts:
763
3i. Total stream and tributary impacts:
763
3j. Comments:
The permanent fords will result in temporary stream impacts due to the fill being below existing streambed
elevation.
E. Impact Justification and Mitigation
i W -ANO .F Zi T. irsI yIIIMFr tiTil
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Avoidance of all impacts is possible only with a no -build alternative, which does not meet the need of the project.
During design, the project corridor was positioned to avoid jurisdictional wetlands, where feasible. Where
avoidance of jurisdictional wetlands was not possible due to constraints, the limits of disturbance were reduced to
the extent practicable.
Avoidance of the streams within the project corridor is not feasible. Stream crossings were designed to reduce the
limits of disturbance. All crossings are designed to be within 15 degrees of perpendicular. Permanent subsurface
fords were designed to allow access to the pipe corridor while providing for a natural streambed.
The design of the project includes placement of anti -seep collars on the pipe upgradient and/or downgradient of
jurisdictional areas.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Impacts to jurisdictional areas during construction will be limited to the extent feasible by performing as much work
as is possible from upland areas. In areas of impact, silt fencing will be placed upgradient of the jurisdictional
areas and all construction activity will be performed upgradient of the silt fencing. All disturbed areas will be
returned to original grade and seeded with a native seed mix within 90 days of completion of the project. Swamp
matting will be used where appropriate in wetland areas. Excavation of the pipe trench will be performed as
prescribed by the USACE in jurisdictional areas and side casting of excavated material into abutting wetland areas
will be avoided to the extent feasible.
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?
f Yes C No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Below threshold for mitigation.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
*** Recent changes to the stormwater rules have required updates to this section .***

1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
f Yes r No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
The project does not include and is not adjacent to protected riparian buffers since North Carolina has not adopted riparian buffer rules for
the project's watershed.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
f Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?*
r Yes
r No
To look up low density requirement click here 15A NCAC 02H.1003(2)
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?
r Yes r No
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 (North Carolina) Environmental Policy Act (NEPA/SEPA)?*
r Yes r No
Comments:
Not required per NC or US rules.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or
DWR Surface Water or Wetland Standards or Riparian Buffer Rules (15A NCAC 2B.0200)? *
r Yes r No
2b. Is this an after -the -fact permit application?*
f Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact
nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
This project is being constructed to enhance operations by removing three (3) existing pump stations and to
protect water quality by allowing adjoining residents to decommission existing septic systems.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r NorN/A

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?*
f Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
f Yes r No
5d. Is another Federal agency involved?*
f Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?
f Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes f No
5g. Does this project involve bridge maintenance or removal?
f Yes r No
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
5h. Does this project involve the construction/installation of a wind turbine(s)?'
r Yes r No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers,
mechanized pile drivers, etc.?
r Yes f No
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this activity on the
property.
Gick the upload button or drag and drop files here to attach docurrent
02202 - Excavation by Blasting.pdf
West Fork 12MC blasting.pdf
File mist be FDF
100.64KB
77.65KB
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS IPaC Trust Resource Report for the project site
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
Review of Essential Fish Habitat designations was performed on-line via the National Oceanic and Atmospheric
Administration, National Marine Fisheries Service's Essential Fish Habitat Mapper.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpoweb/
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 status (e.g., National Historic Trust designation or properties significant in North Carolina history and archaeology)?*
f Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NC State Historic Preservation Office web site and associated links.
7c. Historic or Prehistoric Information Upload

Click the upload button or drag and drop files here to attach docunent
SHPO.pdf 80.88KB
File must be RDF
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA -designated 100 -year floodplain?*
t= Yes r No
8b. If yes, explain how project meets FEMA requirements:
With the exception of manholes, the project does not include aboveground infrastructure that will reduce the flood
capacity of the stream. The project has been designed and will be constructed to avoid permanent or adverse
impacts to the floodplain traversed by the project corridor.
8c. What source(s) did you use to make the floodplain determination?*
GIS data obtained from Union County
Miscellaneous
Miscellaneous attachments not previously requested.
Click the upload button or drag and drop files here to attach docunent
Impact Maps with aerial_rev.pdf 16.45MB
Impact Maps without aerial_rev.pdf 1.53MB
File must be FDF or KW
Signature
rJ By checking the box and signing below, I certify that:
■ I have given true, accurate, and complete information on this form;
■ I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act');
■ I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
■ I intend to electronically sign and submit the PCN form.
Full Name:*
Linda Diebolt
Signature
16"10
Date Submitted:
7/5/2018
Initial Review
Is this project a public transportation project?* (�)
4 Yes f• No
Change only' needed.
Has this project met the requirements for acceptance in to the review process?*
f• Yes
r No

BIMS # Assigned*
20180936
Version#*
Reviewing Office*
Mooresville Regional Office - [phone]
Select Project Reviewer*
Alan Johnson:eads\adjohnson1
Is a payment required for this project?*
f No payment required
f Fee received
r Fee needed - send electronic notification
What amout is owed?*
f $240.00
r $570.00