20010735 Ver 1_Complete File_20100726

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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
May 2, 2001
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of the Neuse Road, Suite 120
Raleigh, North Carolina 27615
ATTENTION: Mr. Eric Alysmeyer
NCDOT Coordinator
LYNDO TIPPETT
SECRETARY
010735
Subject: Nationwide 12 Permit Application: Davidson County, NC 109 over
Abbot's Creek. State Project 8.1601301, Federal Aid Project BRZNHS-
109 (2). TIP No. B-2951
Dear Sir:
The North Carolina Department of Transportation proposes to replace "in place"
Bridge No. 135 on NC 109 over Abbott's Creek. Only 0.02 acres of jurisdictional
wetlands will be impacted by the construction of the project. This impact qualified for a
Nationwide 23 permit (Categorical Exclusion). NCDOT applied for this permit in March
22, 2001.
Project design requires the replacement of an existing utility line across Abbott's
Creek (DWQ Index number 12-119-(1). Impacts on jurisdictional surface waters will be
temporary (0.019 acres). Impacts to jurisdictional wetlands through excavation will not
exceed 0.017 acres. The area to be cleared will be kept to a minimum. Preconstruction
contours will be restored. All material resulting from excavation will be placed so that it
is not dispersed by currents or other forces. Any excess material will be removed to
upland areas and exposed stream banks stabilized immediately upon completion.
Enclosed are drawings of the proposed work, project site map and preconstruction
notification form for the utility line replacement. We have determined that this activity
will be authorized under Nationwide Permit 12. In addition, we anticipate the 401
General Certification will apply to this project, and are providing one copy of these
MAILING ADDRESS: TELEPHONE: [phone] LOCATION:
NC DEPARTMENT OF TRANSPORTATION FAX: [phone] TRANSPORTATION BUILDING
PROJECT DEVELOPMENT AND ENVIRONMENTAL ANALYSIS 1 SOUTH WILMINGTON STREET
1548 MAIL SERVICE CENTER WEBSITE: WWW.DOH.DOT.STATE. NC.US RALEIGH NC
RALEIGH NC 27699-1548

documents to the North Carolina Department of Environment and Natural Resources,
Division of Water Quality, for their review.
The DOT requests that the COE authorize this activity in Davidson County under
a Section 404 Nationwide Permit 12. If you have any questions or need additional
information please call Jeffrey Burleson at [phone] extension 315.
Sincerely, William D. Gilmore, P.E., Manager
Project Development & Environmental Analysis Branch
cc: w/-attachment
Mr. David Franklin, Corps of Engineers, Wilmington Field Office
Mr. Garland Pardue, USFWS, Raleigh
Mr. N. L. Graf, P.E., FHWA
Mr. John Dorney, NCDENR, Division of Water Quality
Mr. Calvin Leggett, P.E. Program Development Branch
Ms. Deborah Barbour, P.E., Highway Design Branch
Mr. D. R. Henderson, P.E., Hydraulics Unit
Mr. Timothy V. Rountree, P.E., Structure Design Unit
Mr. John Alford, P.E., Roadway Design Unit
Mr. S. P. Ivey, P.E., Division 9 Engineer
Mr. Ron Wilkins, P.E., Utilities Section

I
3/25/96
01o735
DEM ID:
CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #): 12
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET).
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL
MANAGEMENT (SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME: N. C. Department of Transportation
2. MAILING ADDRESS: P. 0. Box 25201
CITY: Raleigh
PROJECT LOCATION ADDRESS,
MAILING ADDRESS ABOVE):
SUBDIVISION NAME:
STATE: NC ZIP CODE: 27611
INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
3. TELEPHONE NUMBER (HOME):
(WORK): 733-3141
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL,
ADDRESS, PHONE NUMBER: William D. Gilmore, P.E., Manager
Project Development and Environmental Analysis Branch
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS
TOPOGRAPHIC MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Davidson NEAREST TOWN OR CITY: Thomasville
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):
Bridge NO. 135 on NC 109 over Abbott's Creek in Davidson Count
6. IMPACTED OR NEAREST STREAM/RIVER:
RIVER BASIN: Yadkin
Abbott's Creek
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW),
0

WATER SUPPLY (WS-I OR WS-II)? YES [ ] NO [X] IF YES, EXPLAIN:
1
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)?YES[ ] NO[X]
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR
LIST OF COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
N/A
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON
THIS PROPERTY? YES [ ] NO [X] IF YES, PROVIDE ACTION I.D. NUMBER OF
PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES [ ] NO [X] IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: N/A
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT
SITE:
0.5
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: 0
FLOODING: N/A
DRAINAGE: N/A
TOTAL ACRES TO BE IMPACTED: 0.017
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: 90 FT AFTER: N/A
FT
WIDTH BEFORE (based on normal high water contours): N/A FT
WIDTH AFTER: N/A FT
AVERAGE DEPTH BEFORE: N/A FT AFTER: N/A FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
EXCAVATION: 0.017
OTHER: 0
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING:
14
I,
OTHER: Utilitv relocation
2
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND? N/A
WHAT IS THE EXPECTED POND SURFACE AREA? N/A
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY): See attached drawings
13. PURPOSE OF PROPOSED WORK: To relocate water line crossing over
Abbott's Creek
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS): Because the waterline will have to cross the creek and
wetland system at one place or another to accommodate users on each side
of stream.
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR
PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: n/a (ATTACH RESPONSES FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA.WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED: n/,a
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE
OF PUBLIC (STATE) LAND?
YES [X] NO [] (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN
ENVIRONMENTAL DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH
CAROLINA ENVIRONMENTAL POLICY ACT?
YES [XI NO [I
I
3
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [X] NO [I
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21,
26, 29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE
PROPERTY MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS
50 FEET OR 1 INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY? Agriculture
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
N/A
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.
4i
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OWNER'S/AGEN S SIGNATURE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
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N. C. DEPT. OF TRANSPORTATION
DIVISION OF HIGHWAYS
DAVIDSON COUNTY
PROJECT 8.1601301
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Abbot's Creek, Detour, and Approaches
on NC 109 in Davidson Co.
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N. C. DEPT. OF TRANSPORTATION
DIVISION OF HIGHWAYS
DAVIDSON COUNTY
PROJECT 8.1601301
Replacement of Bridge No. 135 over
Abbot's Creek, Detour, and Approaches
on NC 109 in Davidson Co.
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N. C. DEPT. OF TRANSPORTATION
DIVISION OF HIGHWAYS
DAVIDSON COUNTY
PROJECT 8.1601301
Replacement of Bridge No. 135 over
Abbot's Creek, Detour, and Approaches
on NC 109 in Davidson Co.
SHEET 4 OF 5

SUMMARY
Temporary Fill in Excavation
Site Number Surface Waters in Wetlands
1 .019 ac.
2 .017 ac.
4
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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
May 2, 2001
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of the Neuse Road, Suite 120
Raleigh, North Carolina 27615
ATTENTION: Mr. Eric Alysmeyer
NCDOT Coordinator
LYNDO TIPPETT
SECRETARY
010735
Subject: Nationwide 12 Permit Application: Davidson County, NC 109 over
Abbot's Creek. State Project 8.1601301, Federal Aid Project BRZNHS-
109 (2). TIP No. B-2951.
Dear Sir:
The North Carolina Department of Transportation proposes to replace "in place"
Bridge No. 135 on NC 109 over Abbott's Creek. Only 0.02 acres of jurisdictional
wetlands will be impacted by the construction of the project. This impact qualified for a
Nationwide 23 permit (Categorical Exclusion). NCDOT applied for this permit in March
22, 2001.
Project design requires the replacement of an existing utility line across Abbott's
Creek (DWQ Index number 12-119-(1). Impacts on jurisdictional surface waters will be
temporary (0.019 acres). Impacts to jurisdictional wetlands through excavation will not
exceed 0.017 acres. The area to be cleared will be kept to a minimum. Preconstruction
contours will be restored. All material resulting from excavation will be placed so that it
is not dispersed by currents or other forces. Any excess material will be removed to
upland areas and exposed stream banks stabilized immediately upon completion.
Enclosed are drawings of the proposed work, project site map and preconstruction
notification form for the utility line replacement. We have determined that this activity
will be authorized under Nationwide Permit 12. In addition, we anticipate the 401
General Certification will apply to this project, and are providing one copy of these
MAILING ADDRESS: TELEPHONE: [phone] LOCATION:
NC DEPARTMENT OF TRANSPORTATION FAX: [phone] TRANSPORTATION BUILDING
PROJECT DEVELOPMENT AND ENVIRONMENTAL ANALYSIS 1 SOUTH WILMINGTON STREET
1548 MAIL SERVICE CENTER WEBSITE: WWW.DOH.DOT.STATE. NC.US RALEIGH NC
RALEIGH NC 27699-1548
r
documents to the North Carolina Department of Environment and Natural Resources,
Division of Water Quality, for their review.
The DOT requests that the COE authorize this activity in Davidson County under
a Section 404 Nationwide Permit 12. If you have any questions or need additional
information please call Jeffrey Burleson at [phone] extension 315.
Sincerely,
William D. Gilmore, P.E., Manager
Project Development & Environmental Analysis Branch
cc: w/attachment
Mr. David Franklin, Corps of Engineers, Wilmington Field Office
Mr. Garland Pardue, USFWS, Raleigh
Mr. N. L. Graf, P.E., FHWA
Mr. John Dorney, NCDENR, Division of Water Quality
Mr. Calvin Leggett, P.E. Program Development Branch
Ms. Deborah Barbour, P.E., Highway Design Branch
Mr. D. R. Henderson, P.E., Hydraulics Unit
Mr. Timothy V. Rountree, P.E., Structure Design Unit
Mr. John Alford, P.E., Roadway Design Unit
Mr. S. P. Ivey, P.E., Division 9 Engineer
Mr. Ron Wilkins, P.E., Utilities Section

:
3/25/96
010735
DEM ID:
CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #): 12
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET).
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL
MANAGEMENT (SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME: N. C. Department of Transportation
2. MAILING ADDRESS: P. 0. Box 25201
SUBDIVISION NAME:
CITY: Raleigh STATE: NC ZIP CODE: 27611
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER (HOME):
(WORK) : 733-3141
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL,
ADDRESS, PHONE NUMBER: William D. Gilmore, P.E., Manager
Project Development and Environmental Analysis Branch
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS
TOPOGRAPHIC MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Davidson NEAREST TOWN OR CITY: Thomasville
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):
Bridge NO. 135 on NC 109 over Abbott's Creek in Davidson County
6. IMPACTED OR NEAREST STREAM/RIVER:
RIVER BASIN: Yadkin
Abbott's Creek
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW),

l
WATER SUPPLY (WS-I OR WS-II)? YES [ ] NO [X] IF YES, EXPLAIN:
1
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)?YES[ ] NO[X]
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR
LIST OF COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
N/A
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON
THIS PROPERTY? YES [ ] NO [X] IF YES, PROVIDE ACTION I.D. NUMBER OF
PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES [ ] NO [X] IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: N/A
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT
SITE:
0.5
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: 0
FLOODING: N/A
DRAINAGE: N/A
TOTAL ACRES TO BE IMPACTED: 0.017
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: 90 FT AFTER: N/A
FT
WIDTH BEFORE (based on normal high water contours): N/A FT
WIDTH AFTER: N/A FT
AVERAGE DEPTH BEFORE: N/A FT AFTER: N/A FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
EXCAVATION: 0.017
OTHER: 0
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING:
A
+l
OTHER: Utility relocation
2
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND? N/A
WHAT IS THE EXPECTED POND SURFACE AREA? N/A
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY): See attached drawings
13. PURPOSE OF PROPOSED WORK: To relocate water line crossing over
Abbott's Creek
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS): Because the waterline will have to cross the creek and
wetland system at one place or another to accommodate users on each side
of stream.
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR
PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: n/a (ATTACH RESPONSES FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED: n/a
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE
OF PUBLIC (STATE) LAND?
YES [X] NO [] (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN
ENVIRONMENTAL DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH
CAROLINA ENVIRONMENTAL POLICY ACT?
YES [X] NO [ ]
F

3
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [X] NO [
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21,
26, 29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE
PROPERTY MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS
50 FEET OR 1 INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY? Agriculture
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
N/A
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.

4
OWNER'S/AGEN S SIGNATURE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS. PROVIDED (18g.))
DATE
VICINITY MAP
aw „ (?
1796
Ledford
Middle
School
1756
1225
Ledford Senior
1752 High School
1753
1753
PROJECT 8-2954
1
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BEGIN STATE PROECr 62951
BEGIN F.A. BRNSF4 109M
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SITE 1 v,
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PROPOSED 6"
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SURVEY -L-
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PROPOSED
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ITE 1
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N. C. DEPT. OF TRANSPORTATION
DIVISION OF HIGHWAYS
DAVIDSON COUNTY
PROJECT 8.1601301
Replacement of Bridge No. 135 over
SCALE IN FEET Abbot's Creek, Detour, and Approaches
ILL on NC 109 in Davidson Co.
SHEET 3 OF 5
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N. C. DEPT. OF TRANSPORTATION
DIVISION OF HIGHWAYS
DAVIDSON COUNTY
PROJECT 8.1601301
Replacement of Bridge No. 135 over
Abbot's Creek, Detour, and Approaches
on NC 109 in Davidson Co.
SHEET 4 OF 5
SUMMARY
Temporary Fill in Excavation
Site Number Surface Waters in Wetlands
1 .019 ac.
2 .017 ac.