20010268 Ver 1_Complete File_20010223

a.w
MICHAEL F. EASLEY
GOVERNOR
February 19, 2001
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS
USACOE
Mr. Dave Timpy
PO Box 1890
Wilmington, N.C. 28402-1890
Re: Montgomery Co. Bridge No. 147 Replacement
Location: Montgomery County, SR 1303
Dear Mr. Timpy:
LYNDO TIPPETT
SECRETARY
v
2001
010268
We are providing herewith an application package and copies of N. C. Department of Transportation,
Hydraulics Unit sketches (plan and profile) as part of a project involving the replacement of an existing
bridge with a 25'x8' Precast Box on concrete footings. Construction shall begin in the Summer of 2001.
To our knowledge, no wetlands are involved and total fill in waters is expected to be less than 0.01 acre.
This bridge is not located in a high quality water area.
Please review this material, and if additional information is needed, or you have comments, please contact
our office.
Thank you for your cooperation and assistance in this matter.
Sincerely,
E.B. Nelson, P.E.
Div. Bridge Maint. Engineer
Attachments
cc: Bill Rosser, P.E. - Division Engineer
John Hennessey - DWQ - 7 copies w/ attachments
Mrs. Renee Gledhill-Earley - State Historic Preservation Officer
Mike Crocker - US Fish & Wildlife Service
PAYMENT
RECEIVED
DIV. 8 BRIDGE MAINTENANCE
PO BOX 289 - SILER CITY - NC - 27344
PH. 919.742.5649 FAX [phone]
. . 'i,
01026
DWQ ID:
CORPS ACTION ID:
NATIONWIDE PERtiffT REQUESTED (PROVIDE NATIONWIDE PERMIT -.)
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFCATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MAIyAGEMENT
s
'A.
6
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 MIDST BE SENT TO THE NC DIVISION OF WATER
QUALITY. ATTN: JOHN DORNEY. 4401 REEDY CREEK ROAD.
RALEIGH. NC 27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: N L r? v i
2. MAILING ADDRESS: Pao K Z 9
SUBDIVISION NAME
CITY: S i ?.i??L G lt/ STATE: h.L c_ ZIP CODE:...?- -7 S`4
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
MbMr'L-,oM?t2`? LO. '!,?111?G?? 1147
3. TELEPHONE NUMBER: (HOME)
(WORK) 919 714Z-:4-y9
4. IF APPLICABLE: AGENT'S NAT OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
1C- ' N MA-5 49 ?. I ?
rrn
rn ?
LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: MoNTG?onrt??2^( -NEAREST TOWN: TI2b4
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)

6. IMPACTED OR NEARESTSTREAM/RIVER: ?uNl e7M?Sl£ 6tZs(s (L
RIVER BASIN: V^D 1, 1-j
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING SOURSE WATERS (ORW), WATER _
SUPPLY (WS-I OR WS-IT)? YES ( NO ( IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF EIIVIROMENTAL CONCERN (AEC)? YES ( ) NO (?)
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?
8a. HAVE ANY SECTION 404 P S BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ( ) NO (-?FFYES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT QUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ( ) NO ( IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: o,5
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
N0Niti -
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING:
FLOODING:
DRAINAGE :
EXCAVATION:
OTHER:
TOTAL ACRES TO BE IMPACTED:
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on normal high water contours):
FT
AVERAGE DEPTH BEFORE: FT AFTER: FT
(2) STREAML CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: COONSTRUCTION OF A DAM/FLOODING:
OTHER: P4A-CjS .1rv,vr err Lr?r+LrLr?nz /sD yC
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND?
POND SURFACE AREA?
WHAT IS THE EXPECTED
12. DISCTIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECH.JvICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 8112 BY 11 DRAWINGS ONLY)
?Z?z('Lr4Z? 1?xrST7NGi fSfZt/76;'C W 17"14 ZS''X e 6 W-0%-4-z S1"Y*N
G ?2?f-w r' 09 u6Q4-4 /;-1'b to Tb 91£ a 77 13. PURPOSE OF PROPOSED WORK. Oi-PL/?-nG l7l?r= IGIIL?vT I412rt76rrL_

14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF ANY FEDERALY
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: &-/ Lw-rr 2
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED
61 L ierx-v_
17. DOES THE PROJECT LNVOLVE AN E?TENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES (NO ( ) (IF NO, GO TO 16) _
a. IF YES, DOES THE PROJECT REQUIRE PREPERATION OF AN ENVIRONMENTAL
DOCUMENT PURUANT TO THE REQUIREMENTS OF THE ORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ( ) NO ( r-N
b. IF YES, HAS THE DOCUMENT BEEN REFIEWED THROUGH THE NORTH CAROLINA
DEPARTMEN'T' OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATIONFROM THE STATE
CLEARINGHOUSE 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 OF 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 STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE i INCH EQUALS 50 FEET
OF 1 INCH EQUALS 100 FEET OF THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IllvIPACTED
BY PRODUCT.
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 PROPOERTY?
IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WTLANDS OR WATERS OF THE US 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 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 _
MANAGE_MENI PROGRAM,
g"-, la, z of
OWNER'SIAGENT'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
1 wLU i + NUURnri LCV. r dX • JVJ-(JJ-0?di Jul 2J M 1U 15$ P.04
NANIMUM CRITERIA I)MRbONATION CEMCKLIST
The following questions provide direction In detrmining whether a proposed prajeet ho3 only a
minimum potential for environmental effects. Answer the following questions by checking
either yes or no. Refer to the attached guidance for assistance.
TIP Project No,
State Project No. S, s ti s z
Project Location: -j o ?t-i-, ivwurG?o?,usat y
Proj sot Description..
Anticipated Permit or Consultation Requirements: N w i- --14
Special Project Information:
1
,...uv, i ,w?i?rn•i LLV. r GX•yA?'(00-0J>n Jul 20 2000 10:58 P.05
PAH T A:
MINI1? UM CRI'T'ERIA YES NO
1, Is the proposed, project listed as a type which would qualify e Q
as a Non Major Action under the Minimum Criteria?
PART R: NIINW UM CRITERIA EXCE)Q'TIONS
2. Is the proposed project likely to precipitate sigrdfican#, foreseeable
alterations in land use, planned growth, or devcivpment patterns? „'
3- Does the proposed action divide or disrupt as established eominunity? a l
4. Does the proposed action bypass an e:dsting community?
S. Does the proposed action provide new access to areas containing
signifizant amounts of exploitable amoral resources?
6. Is the proposed action likely to have a significant detrimental impact
on air quality?
7. Is the proposed action likely to have a signifcut dctrimenW impact
on ambient noise levels for adjoining areas?
8. Is the proposed action likely to have a significant impact on travel
patterns or traffic volumes?
9, Is the proposed action likely to significantly affect water quality?
10, Does the proposed action require the relocation of significant numbers
of people? El [a'
1 i. Is the project likely to be controversial? C1 [E?
12. Will the proposed action require the use of land owned by the
U. S. Forest Service or the National Park Service?
PART C: COMPLL4"NCE Wn'H STATE A.NV FEDERAL REGULATIONS
Ecological lm acts
13. Is a federally protected threatened or endangered species, or its habitat,
li d
kely to be impacted by tho proposed action?
14. Does the action requira the placement of fill in waters of the United States?
2
. "dw I r,UUI.rll•+ Lr-v. r ax : tJty-- r?o-35215 Jul 20 2000 10:58 P.06
' r
1S. Does the project require the placement ofa sigdfloant amount of $11 in ?
high quality or relatively rate wetland ecosystems, such as mountain bogs
or One savannahs?
16. Dees the prejeet require stream relocation or clt mial changes? ?
17. Is the proposed action located in an Area of Environmental Concern, 13
as defied in the Coastal Area Management Act?
Cultural Reso es
18. Will the Prejeot have an "'effect" on a property or site listed on the ?
National Register of Historic Places?
19. Will the Proposed action require acquisition of additional right of way C3 31Z
. from publicly owned parkland or recreational areas?
Reviewed by; Date:
Project Planning Engineer
Project Play ring Unit Head
If any questlora 2 through 12 are answered "yes", the proposed project does not qualify as a
Non-Major Action. A state environmental assessment (FA) will be required For assistance,
contact:
Williout D. Gilmore, P. E.
Manager, Project Development and Envirotunental Analysis Branch
P. 0. Box 25201
Raleigh, NC 27611
[phone]
Fax: [phone]
Questions is Pat C are designed to assist the Engineer in-determining whether a permit or
consultation with a state or federal resource agency may be required. If any question in Part C is
answered "yes", refer to the Environmental (luidaneg section of this document and contact the
appropriate individual for assistance.
RECOMMENDED STRUCTURE
IC 25' x 8' CROWN SPAN ON FOOTINGS
OR COMPARABLE CON SPAN
10+00= BEG BR FL
PK NAIL IN
RIP RAPS
FIELD
HEADWALL
06 SR 1134 20' ASPHALT
T.P.
/HEADWALL-
9+50= P.O.T.
PK NAIL IN
WOODS
OG ?\?
Z? \\
o?
10+25.3= END BR FL
PK NAIL IN FL
PASTURE
N 13° 00' E ?- .
-T-.P.\ TBM
.._.. ..mac: -u..?
11+00= P.O.T.
PK NAIL IN PL WOC

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• A .,
®1()268
DWQ ID:
CORPS ACTION ID:
NATIONWIDE PERZ-V11T REQUESTED (PROVIDE NATIONWIDE PERMIT N)
i
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 MUST BE SENT TO THE NC DIVISION OF WATER
QUALITY. ATTN: JOHN DORNEY. 4401 REEDY CREEK ROAD.
RALEIGH, NC 27607. PLEASE PRINT OR TYPE.
PRE-CONSTRUCTION NOTIFICATION APPLICATION
iF,AV,11 I8?
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS n=
2) APPLICATION FOR SECTION 401 CERTIFCATION
') COORDINATION WITH THE NC DMSION OF COASTAL MANAGEMENT
n
1. OWNER'S NAME: N'(_
Z??9
2. MAILING ADDRESS: i->v Soy
SUBDIVISION NAME
CITY: S I L-is?L Gitl STATE: tiL L- ZIP CODE: Z -7 r-N y
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
Go. ??1?nc?? 14-7
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS, n -?{
PHONE NUMBER: m rri
r? ,2 N rf ?-s
7?1 Z-5 y9
3. TELEPHONE NUMBER: (HOME) (WORK) '319
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: M oMTG7onnif.?l ( - NEAREST TOWN: TIZ 04
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)
13 jzi?-.?-(wf- mo , 1,4-7 om SIZ. 13 o 3
6. IMPACTED OR NEAREST STREAMIRIVER: D util l vmis i£ 612 rcfe tf-
RIVER BASIN: y^r;, t, iJ
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OIJTA??tDING R?SOURSE WATERS (ORW), WATER _
SUPPLY (WS-I OR WS-II)? YES (P) NO ( IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIROMENTAL CONCERN (AEC)? YES ( ) NO (
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAIN (LUP) DESIGNATION?
8a. HAVE ANY SECTION 404 PP=S BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ( ) NO (--I IF S, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMTT?QUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ( ) NO ( IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND:
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
Nn
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: _
FLOODING:
DRAINAGE :
EXCAVATION:
OTHER:
TOTAL ACRES TO BE IMPACTED:
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: FT AFTER:
WIDTH BEFORE (based on normal high water contours): FT
AVERAGE DEPTH BEFORE: FT AFTER:
(2) STREtSuM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: COONSTRUCTION OF A DAM/FLOODING:
OTHER: PL/kCjSA v;tvr car= Ld r+ & rL g-rnz- /S c K
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? WHAT IS THE EXPECTED
POND SURFACE AREA?
12. DISCTIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECI-LAMCAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 8112 BY 11 DRAWINGS ONLY)
IZt?z('Lri? ? r=. xis ?n?? /', 2 r/?G ?L wv r y- l; Z S x °? G IZv ?..r? S r?yk?+
GALA-wPIZ E 9xCA-4 1011-brL TU 9Jr- u71 i., Z-K-0
13. PURPOSE OF PROPOSED WORK: 1?,e(2.A2rE >>r?r=rGri£?v-r- i52rt7G,?
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MININIIZE WETLAND IMPACTS)
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF ANY FEDERALY
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: 15,-l L r. Tx-
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED
ISN 1-isTr#f'w-
17. DOES THE PROJECT D4VOLVE AN r• ENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ( NO ( ) (IF NO, GO TO 16) _
a. IF YES, DOES THE PROJECT REQUIRE PREPERAT70N OF AN ENVIRONMENTAL
DOCUMENT PURUANT TO THE REQUIREMENTS OF TI??IORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ( ) NO (
b. IF YES, HAS THE DOCUMENT BEEN REFIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATIONFROM THE STATE
CLEARINGHOUSE 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 OF 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 STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OF 1 INCH EQUALS 100 FEET OF THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED
BY PRODUCT.
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 PROPOERTY?
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WTLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:..
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
Z) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF 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,
OWNER'S/AGENT'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
1 wyu , nuur nri LCV. r dx • 1?-f JJ-JJ25? Jul 1'J 2WU 1U : 58 P. 04
ME MUM CRITERIA D NATION CHECKLIST
The following questions provide direction in determining whether a proposed project ha3 only a
minimum potential for environmenW effects. Answer the following questions by checking
either yes or no. Refer to the attsrhed guidsace for assistwce.
TIP Project No.
State Project No. 5 , ti s z-
Project Location: l?v??na,r? v 1,-1-7 /v,DN-r&O VU" 4
?? G??w,•? sP??+
ProjeatDescription: ?2iP-rLA-r.< 1Srz#r>&o-,
Anticipated Permit or Consultation Requirements: N w P
Special Project Information;
.,...+.v i 1w%J1%r1'1 M-V. rGX`.717'(JJ"`J7C`SJ Ju 20 2000 10:58 P.05
PAKf A; MMMUM CRITERIA YES NO
1, Is the proposed project listed as a type which would qualify v?
as a Non Major Action tuidcr the Minimum Criteria?
PART R: MINLv1UM CRITERIA EXCEPTIONS
2. Is the proposed project likely to precipitate significant, foreseeable
alterations in land use, planned growth, or development patterns?
3_ Does the proposed action divide or disrupt as established community?
4. Does the proposed action bypass an existing oommtmiry? M
5. Does the proposed action provide new access to areas containing
significant amounts of exploitable nasucal resources?
6. Is the proposed action likely to have a significant detrimental impact C3 Er,
on air qualm?
7. Is the proposed action likely to have a sipifir, ut dctrimental impact G,/
on ambient noise levels for adjoining areas?
8. Is the proposed action likely to have a significant impact on travel 1:1
patterns or traffic volumes?
9, Is the proposed action nicely to signiflcantly affect water quality?
10, Does the proposed action require the relocation of significant numbers
of people?
1 i. Is the project likely to be controversial?
12. Will the proposed action require the use of land owned by the
U. S. Forest Service or the National Park Service?
PART C: COMPLIANCE WITH STATE A.'VD FEDERAL REGULATIONS
Zcolog cal Impacts
13. Is a federally .protected threatened or endangered species, or its habitat, CJ U
likely to be i.-npaated by tho proposed action?
14. Does the acdon requirQ the placement of fill in waters of the United States? C] 2

.?? . Nuumnr: LC.v, r dx ; qty- f JJ-J52S5 ju i 20 2000 10:58 P.06

15. Does the project require the placement of a significant amount of 911 in ? `Lf'
high quality or relatively rare wetland ecosystems, such as mountain bogs
or pine savannahs?
16. Does the project require stream relocation or clwmiel changes? ?
17. Is the proposed action located in an Area of Environmental Concern,
as dellned in the Coastal Area Management Act?
Cultural Reso es
18. Will the project have =',effect" on & property or site listed on the
National Register of Historic Places?
19. Will the proposed action require acquisition of additional right of way
from publicly owned parkland or recreational areas?
Reviewed by; Date:
Project Planning Engineer
Project Piaming Unit Head
D C5/,
? o'
If any que3tion3 2 through 12 are answered "yes", the proposed project does not qualify as a
Non-Major Action. A state environmental assessment (EA) will be required. For assistance,
contact:
William D. Gilmore, P. E.
Manager, Project Development and Environmental Analysis Branch
P. O. Box 25201
Raleigh, NC 27611
(919) 7333141
Fax: [phone]
Questions is Pact C are designed to assist the Engineer in-determining whether a permit or
consultation with a state or federal resource agency may be required. If any question in Part C is
answered "yes", refer to the Environmental (Mdance section of this document and contact the
appropriate individual for assistance.
RECOMMENDED STRUCTURE
1@ 25' x 8' CROWN SPAN ON FOOTINGS
OR COMPARABLE CON SPAN
10+00= BEG BR FL
PK NAIL IN CL
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SR 1134 20' ASPHALT
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73 I ,570
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1 1

----------------

M

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7
A
DWQ ID:
010268
CORPS ACTION ID:
NATIONWIDE PER?MTT REQUESTED (PROVIDE NATIONWIDE PERMIT T)
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 MUST BE SENT TO THE NC DIVISION OF WATER
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
C?
1) NOTIFICATION TO THE CORPS OF ENGINEERS - tv
2) APPLICATION FOR SECTION 401 CERTIFCATION ti g
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT a
QUALITY. ATTN: JOHN DORNEY. 4401 REEDY CREEK ROAD.
RALEIGH. NC 27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: N G
2. MAILING ADDRESS: d Pao y 7- 9
SUBDIVISION NAME
CITY: S i L-'svL L ln( STATE: N L- ZIP CODE: Z -7 r-44
PROJECT LOCATION ADDRESS, INCLUDING' SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
nnbtart-,v&.%er2-1 Go. lS?tin6,iE 14-1
3. TELEPHONE NUMBER: (HOME)
?mil z-5 y 9
(WORK) c)19
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
IZL tiZ L hl MA-5 0 r.
LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: M oNTj--0Anr-?l-( - NEAREST TOWN: TI2 04
Fri
n ?
r-r-l
-y

SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)
13 ?2?17c,,? me, (y'1 Ohl SIL 13 o 3
6. IMPACTED OR NEAREST STREA11A/RIVER: 6 tz s(s tG.
RIVER BASIN: V^rn i, iJ
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW) OU.TSTA1?tDING R?FSOURSE WATERS (ORW), WATER _
SUPPLY (WS-I OR WS-H)? YES ( ) NO ( ?S IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIROMENTAL CONCERN (AEC)? YES ( ) No
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?
8a. HAVE ANY SECTION 404 PS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ( ) NO (,') It YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMTQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES( ) NO (L-1 IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: di
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
N0Nirz--
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: _
FLOODING:
DRAINAGE :
EXCAVATION:
OTHER:
TOTAL ACRES TO BE IMPACTED:
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on normal high water contours):
AVERAGE DEPTH BEFORE: FT AFTER:
FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: COONSTRUCTION OF A DAMIFLOODING:
OTHER: PIA-CiS a*tvr c9F 6g ^j e t2 r-Trz. IS o X
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND?
POND SURFACE AREA?
WHAT IS THE EXPECTED
12. DISCTIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECH-- ICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 8112 BY I 1 DRAWINGS ONLY)
IZepL/+-r-r, ??xrs?N4. 62rO6;)£ y?y rrO S' ix a Qz-u%41`i sl"AN
Gr2f}-N?c E Iz?LA'v 1"1-b r2 TLS 9Jr- u7t t' I Z-40
13. PURPOSE OF PROPOSED WORK: rZe 7L A-CfG >>?? I= r G i t£wT i? 2 i t7 G,
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS) -
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF ANY FEDERALY
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: 15,1 I- g'r at
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED
K I L if_Trm4e_ .
17. DOES THE PROJECT INVOLVE AN T ENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES (NO ( ) (IF NO, GO TO 16) _
a. IF YES, DOES THE PROJECT REQUIRE PREPERATION OF AN ENVIRONMENTAL
DOCUMENT PURUANT TO THE REQUIREMENTS OF T?HEE?IORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES( ) NO (
b. IF YES, HAS THE DOCUMENT BEEN REFIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATIONFROM THE STATE
CLEARINGHOUSE 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 OF 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 STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OF 1 INCH EQUALS 100 FEET OF THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED
BY PRODUCT.
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 PROPOERTY?
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WTLANDS OR WATERS OF THE US 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 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,
L? lz?'t z o /
OWNER'S/AGENT'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
110.Lul , NUU"I'i ur-v. rdx•ylt$-(00-0?dS Jul 2J 2WU 1U.58 P.04
lV WIMUM CRITERIA DEMRbONATION CHECKLIST
The following questions provide direction In determining whether a proposed project Im only e
minimum potential for environtuental effects. Answer the following questions by checking
either yes or no. Refer to the attached guidance for Assistance.
TIP Project No.
State Project No. 5 5 ti 5 Z
Project Location: Kv??nc?rc oQv 1&1-7 ivwr.)-r6no"us4q
Pto*tDweriptlon.- r2i Pi?1z iSrzope-itc w/ G1 (aw,,t 5PA-14
Anticipated Permit or Consultation Requirements: N w i- "- 14
Special Project Information:
....+.L• I MWUMMI'l VL-V. rax•yx????-??t5? Jul 20 2000 10:58 P.05
PART' A; MINIMUM CE TERYA YES NO
1, Is the proposed project listed Is & type which would qualify [ ?
as s Non-Major Action under the Minimum Criteria?
PART B; MINLyi UM CRITERIA EXCEPTIONS
2. Is the proposed project likely to precipitate sigmacant, foreseeable
Alterations in land use, pla=cd growth, or development patterns?
3- Does the proposed action divide or disrupt as established community? I,
4. Does the proposed action bypass an existing oommunity?
S. Does the proposed action provide new access to areas containing
significant amounts of exploitable natural resources?
6. Ia the proposed action likely to have a significant detrimental impact
on air quality?
7. Is the proposed action likely to have a signiflout detrimental impact
on ambient noise levels for adjoining areas?
8. Is the proposed action likely to have a significant impact on travel []
patterns or traffic volumes?
9, Is the proposed action likely to significantly affect water quality? E
10. Does the proposed action require the relocation of significant numbers [
of people? 11
I!. Is the project likely to be controversial?
12, Will the proposed action require the use of land owned by the
U. S. Forest Service or the National park Service?
PART C: COMPLIANCE wrrB STATE A..ND FEDERAL REGULATIONS
Ecological impacts
13. Is a fedcrally.protected threatened or endangered species, or its habitat, ? d
likely to be impacted by tho proposed action?
14. Does the action require the placement of fill in waters of the United States? Q
2
1 r UU1\nr+ Lr-v. rdx oy1y-fJJ-J5tS5 Jul 20 2000 10:58 P. C6
' r
15. Does the project require the placement of a significant amount of S11 in ?
high quality or relatively rare wetland ecosystems, such as mountain bogs
orpinasavannahs?
16. Does the project require stream rolocation or chauuel changes? Q
17. Is the proposed action located in an Area of Environmental Concern,
as defted in the Coastal Area Management Act?
Cultural Resoutues
18. Will the project liavc en "effect" on a property or site listed on the
National Register of Historic Places?
19. Will the proposed action require acquisition of additional right of way
fiom publicly owned parkland or recreational areas?
Reviewed by; Date:
Project Planning Engineer
Project Planning Unit Head
? C3/,

If any questiorw 2 through 12 are answered "yes". the proposed project does not qualify as a
Non-Major Action. A state enviro=ental assessment (EA) will be required. For assistance,
contact:
William D. Gilmore, P. a
Manager, Project Development and Environmental AAalysis Branch
P. O. Box 25201
Raleigh, NC 27611
(919) 7333141
Fax: [phone]
Quesiiona in Pat C are designed to assist the Engineer in-detemiiWng whether a permit or
consultation with a state or federal resource agency may be required. if any question in Part C is
answered "yes", refer to the Enviro==tal Chddance section of this document and contact the
appropriate individual for assistance.
RECOMMENDED STRUCTURE
1@ 25' x 8' CROWN SPAN ON FOOTINGS
OR COMPARABLE CON SPAN
10+00= BEG BR FL 10+25.3= END BR FL
PK NAIL IN RIP RAP PK NAIL IN CL
FIELD PASTURE
HEADWALL
N 130 00' E ? .
SR 1134 20' ASPHALT
° T.P.\ TBM
T.P. Gy° -f-
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F
11+00= P.O.T.
9+50= P.O.T.
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