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STATE OF NORTH CAROLINA 1`"rSfCT??;U
DEPARTMENT OF TRANSPORTATION
JAMES B. HUNT JR. P.O. aox 25201, RALEIGH, N.C. 27611-5201 E. NORRIS TOLSON
GOVERNOR SECRETARY
January 29, 1999
MEMORANDUM TO
Ms. Cyndi Bell
DWQ - DENR
COP -J ) 0
FROM:
SUBJECT:
W. D. Gilmore, P. E., Manager
Project Development and Environmental Analysis Branch
Review of Scoping Sheets for the following projects:
Project T.I.P. County Bridge No. State Route Planning Engineer
B-3314 Caldwell No. 163 SR 1502 Dennis Pipkin
B-3448 Davidson No. 166 SR 2775 Dennis Pipkin
B-3459 Granville No. 6 SR 1430 Karen Orthner
B-3125 Caldwell No. 34 SR 1552 Dennis Pipkin
B-3126 Caldwell No. 90 SR 1718 Dennis Pipkin
Attached for your review and comments are the scoping sheets and location maps for the
subject projects. The purpose of this information and the related review procedure is to have an
early "meeting of the minds" as to the scope of work that should be performed and thereby
enable us to better implement the projects. Scoping meetings for these projects are scheduled for
March 2, 1999 in the Planning and Environmental Branch Conference Room (Room 470). These
scoping meetings will be held back to back beginning at 9:00 A. M. in the order shown above.
You may provide us with your comments at the meeting, mail them to us prior to the meeting, or
e-mail them to [e-mail] prior to the meeting.
Thank you for your assistance in this part of our planning process. If there are any
questions about the meetings or the scoping sheets, please call the indicated Project Planning
Engineer, at 733-3141.
WDG/bg
Attachments
I
BRIDGE PROJECT SCOPING SHEET
f
TIP PROJECT: B-3459
F. A. PROJECT: BRSTP-1430(2)
STATE PROJECT: 8.2370701
DIVISION: Five
COUNTY: Granville
ROUTE: SR 1430
DESCRIPTION: Replacement of Bridge No. 6 on SR 1430 over Island Creek
PROJECT PURPOSE: Replace obsolete bridge
PROJECT U.S.G.S. QUAD SHEET(S): Stovall Quad Sheet
ROADWAY CLASSIFICATION: Rural Maior Collector
TIP CONSTRUCTION COST .......................................................................... $ 371,000
TIP RIGHT OF WAY COST .......................................................................... $ 31,000
TIP TOTAL COST ........................................................................................... $ 402,000
TRAFFIC: CURRENT 900 VPD; DESIGN YEAR (2025) 2200 VPD
TTST 1 % DUAL 3 %
EXISTING ROADWAY TYPICAL SECTION: Two lane shoulder section, 20 foot
pavement, grassed shoulders
EXISTING STRUCTURE: LENGTH 11.0 METERS WIDTH 7.3 METERS
36.0 FEET 24.0 FEET
COMMENTS:

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North Carolina
?• Department of Transportation
Division of Highways
Planning & Environmental Branch
Granville County
Replace Bridge No. 6 on NC 1430
Over Island Creek
B-3459
Figure 1
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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
February 28, 2002
U.S. Army Corps of Engineers
Regulatory Field Office
P.O. Box 1890
Wilmington, North Carolina 28402-1890
ATTENTION: Mr. Eric Alsmeyer
NCDOT Coordinator
SUBJECT: Request for NW 33 for Granville County, Bridge No. 6 on SR
1430 over Little Island Creek (Gillis Creek); TIP No. B-3459,
State Project No. 8.2370701; Federal Aid No. BRSTP-1430(2).
Dear Sir:
The NC Department of Transportation (DOT) requested the issuance of a
Nationwide Permit 23 on January 30, 2002. Since the January 30, 2002 letter, a
temporary causeway (two rock pads) as shown on the drawings was added for the use of
placing the drilled shaft interior bents in the new bridge. The temporary impacts to
Jurisdictional Waters of the US are 0.01 acres.
The attached drawings also illustrate the onsite stream relocation designed for the
project as described in the January 30, 2002 Nationwide Permit 23 request. The impacted
reach will fill 95 feet (0.0114 acres if permanent fill in surface waters) of existing stream.
The DOT asks that the construction of a temporary work pad be authorized under
a Nationwide Permit 33 (Temporary causeway and dewatering). Attached for your
information is a copy of the complete permit drawings containing this temporary work
pad and the stream relocation. It is anticipated that a 401 General Water Quality
Certification will apply to this project as well.
If you have any questions or need any additional information, please contact Mr
Jeffrey Burleson at [phone], Extension 315.
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
I
Sincerely,

William D. Gilmore, PE, Manager
Project Development and Environmental
Analysis Branch
WDG/jnb
Attachments
cc: Mr. David Franklin, USACE, Wilmington
Mr. John Dorney, NCDENR, DWQ
Mr. Tom McCartney, USFWS
Mrs. Debbie Barbour, P.E., Highway Design
Mr. Omar Sultan, P.E., Programming and TIP
Mr. John E. Alford, P.E., Roadway Design
Mr. David Chang, P.E., Hydraulics Unit
Mr. Tim Roundtree, P.E., Structure Design Unit
Mr. L. E. Stegall, P.E., Division 5 Engineer
Mr. David Cox, NCWRC, DOT Coordinator

Office Use Only: Form Version April 2001
020385
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
1. Check all of the approval(s) requested for this project:
®Section 404 Permit
Section 10 Permit
® 401 Water Quality Certification
Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: Nationwide 33
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here:
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here:
II. Applicant Information
1. Owner/Applicant Information
Name: NCDOT
Mailing Address: 1 S. Wilmington Street
Raleigh, NC 27611
Telephone Number: 919-733-3141 Fax Number: 919-733
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: n/a
Company Affiliation: n/a
Mailing Address: n/a
Telephone Number: n/a Fax Number: n/a
E-mail Address: n/a
Page 3 of 12

W
Y
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than l l by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Bridge No. 6 on SR 1430 Over Little Island Creek (Gillis Creek
2. T.I.P. Project Number (NCDOT Only): B-3459
3. Property Identification Number (Tax PIN): n/a
4. Location
County: Granville Nearest Town: Stovall
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): Bridge No. 6 on SR 1430 Over
Little Island Creek (Gillis Creek)
5. Site coordinates, if available (UTM or Lat/Long): n/a
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
NW and SW quadrants are scrub shrub and NE and SE quadrants are forested
7. Property size (acres): n/a
8. Nearest body of water (stream/river/sound/ocean/lake): Little Island Creek (Gillis Creek)
9. River Basin: Roanoke
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at htti):Hh2o.enr.state.nc.us/admin/maps/.)
Page 4 of 12
k
10. Describe the purpose of the proposed work: Bridge replacement with temporary work pad
11. List the type of equipment to be used to construct the project: heave equipment
12. Describe the land use in the vicinity of this project: agriculture
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: no
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 5 of 12
A
1. Wetland Impacts
Wetland Impact
Site Number
(indicate on map)
Type of Impact* Area of
Impact
(acres) Located within
I00-year Floodplain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
N/A N/A N/A N/A N/A N/A

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at httn://www.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: n/a
Total area of wetland impact proposed: N/A
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(indicate on map)
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please specify)
1 Rip-rap causeway - Little Island Creek 8 Perennial
2 Stream relocation 95 UT to Little Island Creek 2 Intermittent

_J
* List each impact separately and identity temporary impacts. impacts utciuoe, but are not nmaea to: curveris and assoc,ateu Ilp-lap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.Kov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.coin,
w%vw.maoquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 95
Page 6 of 12
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site Number
(indicate on map)
Type of Impact* Area of
Impact
(acres) Name Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)
1 Temporary Fill in SW 0.0100 Little Island Creek Perennial stream
2 Fill in SW 0.01 UT to Gillis Creek Intermittent stream

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): E] uplands ? stream E] wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): n/a
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): n/a
Size of watershed draining to pond: n/a Expected pond surface area: n/a
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
Bridge will be replaced by a bridge versus replacement with a culvert.
During bridge demolition, the timber/steel/concrete bridge will be removed without dropping
any of their components into the Waters of the US.
No runoff from the bridge will discharge directly into the stream.
Page 7 of 12

VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
httL: //h2o. enr. state. nc. us/ncwetlands/strm gi de. htm 1.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
Mitigation is not applicable
Page 8 of 12
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at http://h2o.eni,.state.nc.us/wry/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet): n/a
Amount of buffer mitigation requested (square feet): n/a
Amount of Riparian wetland mitigation requested (acres): n/a
Amount of Non-riparian wetland mitigation requested (acres): n/a
Amount of Coastal wetland mitigation requested (acres): n/a
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ® No R
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ® No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Page 9 of 12

Yes ? No ® If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet) Multiplier Required
Mitigation
N/A N/A N/A N/A

Total
Zone I extends out 31) feet perpendicular trom near bank of channel; Gone l extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or .0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
XII. Sewage Disposal (DWQ Only)
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.
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes F] No
Is this an after-the-fact permit application?
Yes ? No
Page 10 of 12
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
n/a
,c
0.9. ? /,,?
z6/zooZ-
Applicant/Agent's Sigy ature `Date)
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell Union
US Army Corps of Engineers Avery Clay Jackson Polk Watauga
151 Patton Avenue Buncombe Cleveland Lincoln Rowan Yancey
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham Wilson
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes Yadkin
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret* Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans *Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Page 11 of 12

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VICINITY
MAIDS
N. C. DEPT. OF TRANSPORTATION
DIVISION OF HIGHWAYS
GRANVILLE COUNTY
PROJECT: 8.2370701 (B-3459)
BRIDGE NO.6 ON SR 1430 OVER
THE ISLAND CREEK
? NORTH C`:A
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PROPERTY OWNERS
PARCEL NAME ADDRESS
YEARGIN INSURANCE AGENCY, INC. P.O. Box 1078
I Attn.: Ms. Jean Gill OXFORD. NC 27565
ROGER G.OLMSTED &
2 STEPHEN R.OLMSTED
5618 BRECKEN RIDGE TRAIL
CLAYTON, OH 45315
8
3613 HILLAIRY RD.
3 HERBERT GREGORY,Jr. OXFORD, NC 27565

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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
February 28, 2002
U.S. Army Corps of Engineers
Regulatory Field Office
P.O. Box 1890
Wilmington, North Carolina 28402-1890
ATTENTION: Mr. Eric Alsmeyer
NCDOT Coordinator
LYNDO TIPPETT
SECRETARY
020335
SUBJECT: Request for NW 33 for Granville County, Bridge No. 6 on SR
1430 over Little Island Creek (Gillis Creek); TIP No. B-3459,
State Project No. 8.2370701; Federal Aid No. BRSTP-1430(2).
Dear Sir:
The NC Department of Transportation (DOT) requested the issuance of a
Nationwide Permit 23 on January 30, 2002. Since the January 30, 2002 letter, a
temporary causeway (two rock pads) as shown on the drawings was added for the use of
placing the drilled shaft interior bents in the new bridge. The temporary impacts to
Jurisdictional Waters of the US are 0.01 acres.
The attached drawings also illustrate the onsite stream relocation designed for the
project as described in the January 30, 2002 Nationwide Permit 23 request. The impacted
reach will fill 95 feet (0.0114 acres if permanent fill in surface waters) of existing stream.
The DOT asks that the construction of a temporary work pad be authorized under
a Nationwide Permit 33 (Temporary causeway and dewatering). Attached for your
information is a copy of the complete permit drawings containing this temporary work
pad and the stream relocation. It is anticipated that a 401 General Water Quality
Certification will apply to this project as well.
If you have any questions or need any additional information, please contact Mr.
Jeffrey Burleson at [phone], Extension 315.
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.DORDOT.STATE.NC.US RALEIGH NC
RALEIGH NC 27699-1548
i
Sincerely,
v G
William D. Gilmore, PE, Manager
Project Development and Environmental
Analysis Branch
WDG/jnb
Attachments
cc: Mr. David Franklin, USACE, Wilmington
Mr. John Dorney, NCDENR, DWQ
Mr. Tom McCartney, USFWS
Mrs. Debbie Barbour, P.E., Highway Design
Mr. Omar Sultan, P.E., Programming and TIP
Mr. John E. Alford, P.E., Roadway Design
Mr. David Chang, P.E., Hydraulics Unit
Mr. Tim Roundtree, P.E., Structure Design Unit
Mr. L. E. Stegall, P.E., Division 5 Engineer
Mr. David Cox, NCWRC, DOT Coordinator
16.

Office Use Only: Form Version April 2001
02 o ' 15
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
1. Check all of the approval(s) requested for this project:
®Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: Nationwide 33
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: n
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here:
II. Applicant Information
Owner/Applicant Information
Name: NCDOT
Mailing Address: 1 S. Wilmington Street
Raleigh, NC 27611
Telephone Number: 919-733-3141 Fax Number: 919-733-9794
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: n/a
Company Affiliation: n/a
Mailing Address: n/a
Telephone Number: n/a
E-mail Address: n/a
Fax Number: n/a
Page 3 of 12

III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing pro]
boundaries and development plans in relation to surrounding properties. Both the vicinity
and site plan must include a scale and north arrow. The specific footprints of all build
impervious surfaces, or other facilities must be included. If possible, the maps and plans st
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the pro]
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discrc
so long as the property is clearly defined. For administrative and distribution purposes
USACE requires information to be submitted on sheets no larger than 11 by 17-inch fol
however, DWQ may accept paperwork of any size. DWQ prefers full-size constru
drawings rather than a sequential sheet version of the full-size plans. If full-size plan;
reduced to a small scale such that the final version is illegible, the applicant will be informec
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Bridge No. 6 on SR 1430 Over Little Island Creek (Gillis Creek
2. T.I.P. Project Number (NCDOT Only): B-3459
3. Property Identification Number (Tax PIN): n/a
4. Location
County: Granville Nearest Town: Stovall
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): Bridge No. 6 on SR 1430
Little Island Creek (Gillis Creek)
5. Site coordinates, if available (UTM or Lat/Long): n/a
(Note - If project is linear, such as a road or utility line, attach a sheet that separately list
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
NW and SW quadrants are scrub shrub and NE and SE quadrants are forested.
7. Property size (acres):
8. Nearest body of water (stream/river/sound/ocean/lake): Little Island Creek (Gillis Cref
9. River Basin: Roanoke
(Note - this must be one of North Carolina's seventeen designated major river basins.
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
Page 4 of 12

10. Describe the purpose of the proposed work: Bridge replacement with temporary work pad
11. List the type of equipment to be used to construct the project: heavy equipment
12. Describe the land use in the vicinity of this project: agriculture
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
n/a
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: no
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 5 of 12
I
1. Wetland Impacts
Wetland Impact
Site Number
(indicate on map)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
N/A N/A N/A N/A N/A N/A

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://www.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: n/a
Total area of wetland impact proposed: N/A
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(indicate on map)
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please specify)
1 Rip-rap causeway - Little Island Creek 8 Perennial
2 Stream relocation 95 UT to Little Island Creek 2 Intermittent

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usks.90v. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.coin,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 95
Page 6 of 12

3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site Number
(indicate on map)
Type of Impact* Area of
Impact
(acres) Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)
1 Temporary Fill in SW 0.0100 Little Island Creek Perennial stream
2 Fill in SW 0.01 UT to Gillis Creek Intermittent stream

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): F-1 uplands ? stream E] wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): n/a
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): n/a
Size of watershed draining to pond: n/a Expected pond surface area: n/a
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
Bridge will be replaced by a bridge versus replacement with a culvert.
Durine bridge demolition. the timber/steel/concrete bridge will be removed without dronnine
any of their components into the Waters of the US.
No runoff from the bridge will discharge directly into the stream.
Page 7 of 12
}
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmgide.htm1.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
Mitigation is not applicable
Page 8 of 12
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wrp/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet): n/a
Amount of buffer mitigation requested (square feet): n/a
Amount of Riparian wetland mitigation requested (acres): n/a
Amount of Non-riparian wetland mitigation requested (acres): n/a
Amount of Coastal wetland mitigation requested (acres): n/a
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ® No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ® No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ® No
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Page 9 of 12
Yes ? No ® If you answered "yes", provide the following informati,
Identify the square feet and acreage of impact to each zone of the riparian buffers. If b
mitigation is required calculate the required amount of mitigation by applying the b
multipliers.
Zone* Impact
(square feet) Multiplier Required
Mitigation
N/A N/A N/A N/A

Total
Lone 1 extends out 30 feet perpendicular from near bank of cnannel; Gone L extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Don,
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservati(
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate informatic
identified within 15A NCAC 2B .0242 or .0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the
Discuss stormwater controls proposed in order to protect surface waters and wet]
downstream from the property.
XII. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharg,
wastewater generated from the proposed project, or available capacity of the subject facility.
n/a
XII1. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes E] No
Page 10 of 12
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
c.

Z6/z0Oz-
Applicant/Agent's SiAature 'Date/
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell Union
US Army Corps of Engineers Avery Clay Jackson Polk Watauga
151 Patton Avenue Buncombe Cleveland Lincoln Rowan Yancey
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham Wilson
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes Yadkin
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret* Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans *Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Page 11 of 12

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VICINITY
MAPS
N. C. DEPT. OF TRANSPORTAT]
DIVISION OF HIGHWAYS
GRANVILLE COUNTY
PROJECT: 8.2370701 (B-3459)
BRIDGE NO.6 ON SR 1430 OV
THE ISLAND CREEK
SHEET I OF 6 DATE 121050
NORTH c_, A

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P- ROPERTY OWNERS
PARCEL NAME ADDRESS
YEARGIN INSURANCE AGENCY. INC. P.O. Box 1078
Attn.: Ms. Jean GIII OXFORD. NC 27565
ROGER G. OLMSTED &
2 STEPHEN R.OLMSTED
3 HERBERT GREGORY. Jr.
5618 BRECKEN RIDGE TRAIL
CLAYTON, OH 45315
3613 HILLAIRY RD.
OXFORD, NC 27565
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