20021004 Ver 1_Complete File_20020624

e??o
STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
June 21, 2002
0'21004
LYNDO TIPPETT
SECRETARY
N.C. Dept. of Environment and Natural Resources-Division of Water 1
2321 Crabtree Blvd.
Raleigh, NC 27604-2260
Attention: Mr. John Dorney
Coordinator
'?I?y 2 4 20o2
_ DI
Subject: Proposed replacement of Bridge No. 29 on SR 1208 in Warren County.
NCDOT Work Order No. 6.503461.
Reference: NCDOT permit application (June 21, 2002)
The North Carolina Department of Transportation (NCDOT) plans to replace
Bridge No. 29 on SR 1208 in Warren County. Construction of the project will
necessitate impacts to waters of the United States. Applications was made for a
Department of the Army Section 404 Nationwide Permit (NWP) 3 and North Carolina
Department of Environment and Natural Resources-Division of Water Quality (DWQ)
Section 401 Water Quality Certification (WQC) No. 3376 by permit application dated
June 21, 2002.
An automated payment procedure has recently been implemented between the
NCDOT and NCDWQ. This procedure will enable the Division to apply for the 401
WQC without submitting a check for this permit application. This new procedure will
provide payment to the NCDWQ by charging the permit application fee directly to the
appropriate NCDOT work order.
The NCDOT work order for this project is 6.503461. Project impacts are less
than one acre of cumulative wetland/water impacts and less than 1,50 linear feet
cumulative impacts to streams: therefore, please note that a fee of $200.00 is required for
this project. If you have any questions or need additional information, please contact me
at [phone].
Sincerely,
Christopher A. Murray, P.W.S.
Environmental Officer
PAYMEEN7
Division 5, 2612 N. Duke Street, Durham, NC 27704 R r' LCCEI VED
Phone: [phone] Fax: [phone]
N C. DEPARTMENT OF TRANSPORTATION

TRANSMITTAL SLIP' DATE

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TO: - REF. NO. OR ROOM, BLDG.
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FROM: - REF. NO. OR ROOM, BLDG.
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? NOTE AND FILE - ? PER OUR CONVERSATION
? NOTE AND RETURN TO. ME ? PER YOUR REQUEST
? RETURN WITH MORE DETAILS ? FOR YOUR APPROVAL
?. NOTE AND SEE ME ABOUT THIS ? FOR YOUR INFORMATION
? PLEASE ANSWER ? FOR YOUR COMMENTS
?PREPARE REPLY FOR MY SIGNATURE ? SIGNATURE'
? TAKE APPROPRIATE ACTION ? INVESTIGATE AND REPORT
COMMENTS:
021004
021004
?? 2 q
STATE of NORTH CAROLINA`.k?C,`?Ie°OS
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
CiovERNoR
June 21, 2002
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of the Neuse Road, Suite 120
Raleigh, NC 27609
LYNDO TIPPETT
SECRETARY
Attention: Mr. Eric Alsmeyer
NCDOT Coordinator
Subject: Replacement of Bridge No. 29 over Smith Creek on SR 1208 in Warren
County. NCDOT Work Order 6.503461.
The North Carolina Department of Transportation (NCDOT) proposes to replace
Bridge No. 29 over Smith Creek on SR 1208 in Warren County (Figure 1). The existing
bridge was constructed in 1975 and has a sufficiency rating of 27.1 out of 100. The
existing structure is a six span bridge (1@ 18'-0", 1@ 16'-6", 1@ 22'-3", 1@ 22'-0", 1@
16'-6", 1 @ 18'-3") that is comprised of timber decking on steel beams with timber joists
on timber caps and timber piles. It has been determined that this structure must be
replaced. The proposed replacement structure is a three-span cored slab bridge (1@ 40%
0", 1 @ 50'-0", 1@ 40'-0") (Figures 2).
Impacts to the Waters of the United States
Construction of the project involving replacement of the existing bridge will
necessitate impact to waters of the United States in the Roanoke River basin. Here the
project crosses Smith Creek (NCDENR-DWQ Index No. 23-10, Best Usage
Classification Q.
Bridge Demolition and Removal
Bridge No. 29 will be removed under Case 3, where there are no special
restrictions beyond those outlined in Best Management Practices for Protection of
Surface Waters and Best Management Practices for Bridge Demolition and Removal.
This activity will involve removal of the bridge deck, wing wall abutment/pilings and
timber pilings. A silt fence and/or turbidity curtain will be placed around these structures
(where necessary) to reduce sedimentation during construction activity. The bridge shall
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Division 5, 2612 N. Duke Street, Durham, NC 27704
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Project Site
acement of Bridge No. 29 on
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be removed by sawing and/or non-shattering methods such that debris will not fall into
waters of the United States.
Bridge Replacement
The proposed structure is a three-span cored slab bridge over Smith Creek. End
bents 1 and 2 will be driven and bents 1 and 2 will be drilled (Figure 2). Class II rip rap
will also be placed along the wing walls (of the existing bridge that will be removed) and
along the banks of Smith Creek. This rip rap will catch and filter runoff from the project
and stabilize the creek bank.
Approximately 34 feet of rip rap will be placed along the north stream bank and
approximately 33 feet of rip rap will be placed along the south stream bank.
Additionally, the project will impact <0.01 acre fill in surface water and <0.01 acre fill in
wetlands. Please note that the wetland impact is restricted to the placement of rip rap
along the existing western win wall that will be removed) on the north side of Smith
Creek and at the base of the side slope along SR 1208 The placement of rip ran will oWy
be used to stabilize the area adjacent to the existing will wall that will be removed and at
the base of the side slope along SR 1208 for stabilization purposes only The wetland is
described as Palustrine, Emergent, Non-persistent with a saturated water regime.
Wetland delineations were conducted using the field delineation method outlined in the
1987 Corps of Engineers Wetland Delineation Manual (Environmental Laboratory,
1987). U.S. Army Corps of Engineers (USACE) Wetland Data Forms and a North
Carolina Division of Water Quality (DWQ) Wetland Rating Form are attached to this
application. The wetland has a DWQ rating of 50.
Waters of the U.S. Mitigation
Avoidance: All wetlands or surface waters not affected by the project will be
protected from unnecessary encroachment. No staging of construction equipment or
storage of construction supplies will be allowed in or near wetlands or surface waters.
The bridge shall be removed by sawing and/or non-shattering methods such that debris
will not fall into waters of the United States.
Minimization: Strict enforcement or sedimentation and erosion control by Best
Management Practices for the protection of wetlands and surface waters will be enforced
during project construction. Continued coordination will occur with maintenance forces
and the Environmental Officer during construction to minimize impacts to waters or the
United States. The Division Environmental Officer will consult with the contractor
during construction to continue the minimization of Class II rip rap in waters of the
United States at the project.
Compensatory Mitigation: Construction of the project will result in only minimal
impacts to waters of the United States. Impacts have been minimized to the fullest extent
possible during the design process. Due to minimal impacts, compensatory mitigation for
impacts to waters of the U.S. will not be provided for this project.
Historical Compliance
Historic compliance work to be scheduled and concurrence with Historic
Preservation Office will be obtained if required.
Protected Species
dwarf wedgemussel --Biological Conclusion: No Effect
Tar spinymussel- Biological Conclusion: No Effect
NCDOT Division Environmental Officer Chris Murray and NCDOT Biologist
Sharon Snider visited the site on May 1, 2002. Smith Creek at the project study area does
not provide suitable habitat for the Tar spinymussel and dwarf wedgemussel. A review
of the NHP rare and unique habitat database did not reveal the presence of these species
within 1.6 km (1.0 mi) of the project study area. Impacts to these federally protected
species will not occur from project construction.
Summary
NCDOT proposes to replace Bridge No. 29 on SR 1208 in Warren County. The
proposed replacement structure is a three-span cored slab bridge. Approximately 34 feet
of rip rap will be placed along the north stream bank and approximately 33 feet of rip rap
will be placed along the south stream bank. Additionally, the project will impact <0.01
acre fill in surface water and <0.01 acre fill in wetlands.
The NCDOT asks that the construction of this project be authorized under a
Department of the Army Section 404 Nationwide Permit No. 3 and North Carolina
Department of Environment and Natural Resources-Division of Water Quality Section
401 Water Quality Certification (WQC) No. 3376. The NCDOT will adhere to all
applicable Section 404 NWP and Section 401 WQC conditions. A pre-construction
notification is attached with this request. If you have any questions or need additional
information, please contact me at [phone].
Sincerely,
Christopher A. Murray, P.W.S.
Environmental Officer
cc: Mr. John Dorney, NCDWQ, Raleigh
Mr. Dallie Bagwell, NCDOT Bridge Superintendent, Raleigh
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: -9 29 ?. 5 Q 12 ,:?, Date: :3• t , 2
Applicant/Owner: A) C- 3:) o1? County: t.,?rr
Investigator: State: ly
Do Normal Circumstances exist on the site? Yes N Community ID: S? 4C.
Is the site significantly disturbed (Atypical Situation)? es a Transept ID: t )e+??ti9
Is the area a potential Problem Area? Yes Plot ID:
(If needed, explain on reverse.)
VEGETATION
Dominant Plant Species Stratum Indicator Dominant Plant Species Stratum Indicator
1. ?ar2?c ?n 9.
rr rn
2. unt. ?? 2 'Y Ls _FL ACwa^ 10.
3• SR oc.,'? ca... e n 1 - YRc?a' 11.
4._ c4j-, li C, 12.
5. 13.
6. 14.
7. 15.
8. 16.
Percent of Dominant Species that ara.O8L, FACW or FAC
CO 019
(excluding FAC-). 0
Remarks:
5p-2.CaeS 0-
HYDROLOGY
Recorded Data (Describe in Remarks): Wetland Hydrology Indicators:
_
Stream, Lake, or ride Gauge Primary Indicators:
_ Aerial Photographs _ Inundated
Other
-/No Rec_orded Data Available ::/Saturated in Upper 12 Inches
_ Water Marks
-/Drift Lines

Sediment Deposits
Field Observations: _ 6rainage Patterns in Wetlands
Secondary Indicators (2 or more required):
Depth of Surface Water: (in.) _ Oxidized Root Channels in Upper.12 Inches
_ Water-Stained Leaves
Depth to Free Water in Pit: (in.) _ Local Soil Survey Data
_ FAC-Neutral Test
Depth to Saturated Soil: (in.) _ Other (Explain in Remarks)
Remarks: \ p t
-eQ
SOILS
Map Unit Name
(Series and Phase): Drainage Class:
Field Observations
Taxonomy (Subgroup): Confirm Mapped Type? Yes No
Profile Description:
Depth Matrix Color Mottle Colors Mottle Texture, Concretions,
inches Horizon (Munsell Moist) (Munsell Moist) Abundance/Contrast Structure, etc.
V'4{ (o"?26 ( cAO--t?o %-C,
t{-i21- ??`i `?t2blZ 5-t2S I Sorg-

i ?
i Hydric Soil Indicators:
Histosoi _ Concretions
j Histic Epipedon _ High Organic Content in Surface Layer in Sandy Soils i
_ Sulfidic Odor _ Organic Streaking in Sandy Soils
_ Aquic Moisture Regime _ Listed on Local Hydric Soils List
_ Reducing Conditions _ Listed on National Hydric Soils List '
?Gleyed or Low-Chroma Colors _ Other (Explain in Remarks)
Remarks:
!-1,'V. S a',` ?S PreSR.t f- C' f- S-;
WETLAND DETERMINATION
Hydrophytic Vegetation Present? No (Circle)
Wetland Hydrology Present? No
Hydric Soils Present? - 9 No Is this Sampling Point Within a Wetland?
Remarks:
(Circle)
Zes No

All c.-slam„ Q-,,^e-k S cr-P-- . e f qf- s1 je
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: , Z`t ? .. S fZ Z `3 Date: Y- I o ?
Applicant/Owner: k L_Z) o) County:
Investigator: C. PA--, r r State: .N C_
Do Normal Circumstances exist on the site? No
t Community ID: 5
Is the site significantly disturbed (Atypical Situation)7 s o Transect ID: 1, let
Is the area a potential Problem Area? Yes Plot ID:
(if needed, explain on reverse.)
VEGETATION
Dominant Plant Species Stratum Indicator Dominant Plant Species Stratum Indicator
1. LD n, Cep A. ? FAC " 9.
2. 9-0S 10.

4. FAC 12.
5.0G-r.1 a tJr-t.?Eo'S c? yPC- 13.
6. 01 ^-,,) 0,04-20. C CxA C, it C-1 14.
7.Sa--?jvcuS ca?AQe?s.s FRcw? 15.
8. ?. n o t y c..? .? h_ l Ci 1 S.
Percent of Dominant Species that are.OBL, FACW or FAC
(excluding FAC-). (cam
Remarks:
Qc-e.-?.lc-•ce ??-
V0, ? p l?C?r L
S,? e c ? eS ct ?' S i {-?

HYDROLOGY
Recorded Data (Describe in Remarks): Wetland Hydrology Indicators:
_
Stream, Lake, or Tide Gauge Primary Indicators:
Aerial Photographs _ Inundated
_
Other -Saturated in Upper 12 Inches
_
No Recorded Data Available _ Water Marks
Drift Lines
_
_ Sediment Deposits
Field Observations: _ Drainage Patterns in Wetlands
Secondary Indicators (2 or more required):
Depth of Surface Water: (in.) Oxidized Root Channels in Upper.12 Inches
Water-Stained Leaves
Depth to Free Water in Pit: (in.) _ Local Soil Survey Data
_ FAC-Neutral Test
Depth to Saturated Soil: (in.) _ Other (Explain in Remarks)
Remarks: \\ p ^
SOILS
Map Unit Name
(Series and Phase): Drainage Class:
Feld Observations
Taxonomy (Subgroup): Confirm Mapped Type? Yes No
Profile Description:
Depth Matrix Color Mottle Colors Mottle Texture, Concretions,
inc
oist) (Munsell Moist)
es Horizon (Munsell Abundance/Contrast Str
cture. etc.
h
M u

Hydric Soil Indicators:
_ Histosol _ Concretions
_ Histic Epipedon _ High Organic Content in Surface Layer in Sandy Soils
_ Sulfidic Odor _ Organic Streaking in Sandy Soils
_ Aquic Moisture Regime _ Listed on Local Hydric Soils List
_ Reducing Conditions _ Listed on National Hydric Soils List
Gleyed or Low-Chroma Colors _ Other (Explain in Remarks)
Remarks:
N v^ -c c,
F

s,
WETLAND DETERMINATION
Hydrophytic Vegetation Present? (!?j) No (Circle) (Circle)
Wetland Hydrology Present? Yes
Hydric Soils Present? Yes o Is this Sampling Point Within a Wetland? Yes rlqlo?
Remarks:
N v n - w r.? `a.,,9 . a ? ? ? a ? ?+^c.?cr? ?t ? ?1 n'i"- ? f>!Yt-,?- ??- 5• ? ?
Approved by H /
WETLAND RATING WORKSHEET Fourth Version
Project Name: vn i? 1 Nearest road: 5-4 2 `' a
County: Wetlandarea: -L acres Wetland width: feet
Name of evaluator: e . M_s r r- -?--, Date: S . o Z
Wetland location
on pond or lake
on perennial stream
on intermittent stream
within interstream divide
other:
Soil series
predominantly organic
Aumus, muck, or peat)
predominantly mineral
(non-sandy)
predominantly sandy
Hydraulic factors
_ steep topography
ditched or channelized
- total riparian wetland width > 100 f1
Adjacent land use (within 1/: mile upstream,
upslope, or radius)
forested/natural vegetation `f S
agriculture, urban/suburban 5-Clo
impervious surface S %
Dominant vegetation
1) T- ?w5 c ?-I .Aos_
2) ?-C 4-lc 5 D.
3) ;4gAi-efi r..?`in lll?LCi
Flooding and wetness
semipermanently to permanently flooded
or inundated or 5wt- cq k
seasonally flooded or inundated
intermittently flooded or temporary
surface water
no evidence of flooding or surface water
Wetland type (select one)
Bottomland hardwood forest Pine savanna
Headwater forest Freshwater marsh
Swamp forest Bog/fen
Wet flat Ephemeral wetland
Pocosin Carolina Bay
Bog forest Other
*The rating system cannot be applied to salt or brackish marshes or stream channels.
................. ...................... ..... ............ ..................... ............................._......................................................................................................................................................
R Water Storage Z x 4.00 = $
A Bank/Shoreline Stabilization x 4.00 = 12-
T Pollutant Removal 3 x 5.00 = K_ Total Score
I Wildlife Habitat 3 x 2.00 = 6-
S
N Aquatic Life x 4.00 = S
G Recreation and Education x 1.00 =
'Add 1 point if in sensitive watershed and >10% nonpoint disturbance within'/2 mile radius.
ILL-
OF.w V3 A TAR
O QG
Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U. S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
ham://www.saw.usace.army.miI/wetlands/Perm app.htm.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at http://www.saw.usace.army.miI/wetlands/re?ltour.htm, or contact one of the field
offices listed at the end of this application. The website also lists the responsible project manager for
each county in North Carolina and provides additional information regarding the identification and
regulation of wetlands and waters of the U. S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by thL-USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h2o.enr.state.nc.us/ncwetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for some General Certifications is not required,
provided that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet
should contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is also required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on the last page of this application).
Page 1 of 11
CAMI A Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DCM) at [phone]. DCM will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (CAMA) Permit and will coordinate
the 404/401 Permits.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). Upon receipt of an application, the USACE will determine if the application is complete as
soon as possible, not to exceed 30 days. This PCN form is designed for the convenience of the applicant
to address information needs for all USACE Nationwide, Regional or General permits, as well as
information required for State authorizations, certifications, and coordination. Fully providing the
information requested on this form will result in a complete application for any of the USACE
Nationwide, Regional or General permits. To review the minimum amount of information that must be
provided for a complete PCN for each USACE Nationwide permit, see Condition 13, 65 Fed.Reg. 12893
(March 9, 2000), available at http://www.sa,,,v.usace.army.mil/wetlands/nwpfinalFedRe.a,.pdf.
Processing times vary by permit and begin once the application has been determined to be complete.
Please contact the appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at http://h2o.ehnr.state.nc.us/ncwetiands/fees.html. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter)-that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 11
Office Use Only: O n 1 o O ? orm Version April 2001
USACE Action ID No. DWQ No. G
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
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: NWP 3
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
Owner/Applicant Information
Name: NCDOT/Christopher A. Murray
Mailing Address: 2612 N. Duke Street Durham NC 27704
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: [e-mail]
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:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
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
Page 3 of 11
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 11 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. 29 over Smith Creek on SR 1208 in Warren County
2. T.I.P. Project Number (NCDOT Only): Work Order No. 6.503461
3. Property Identification Number (Tax PIN):
4. Location
County: Warren Nearest Town: Oine
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.):_ From I-85 northbound, take Exit
No. 229 (Dine Exit) and turn left and travel north east on SR 1210, turn left and travel north
on SR 1208 to project limits.
5. Site coordinates, if available (UTM or Lat/Long): 17 747166E 4045564N UTM
(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: Site is
surrounded by wooded land.
7. Property size (acres): Project footprint is 420 feet long; and has a right of way of 60 feet.
Property size is approximately 0.58 acre.
8. Nearest body of water (stream/river/sound/ocean/lake): Smith Creek
9. River Basin: Roanoke River
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state,nc.us/admin/maps/.)
10. Describe the purpose of the proposed work: Replacement of Bridge No. 29 over Smith
Creek on SR 1208 in Warren County. The replacement structure is a 1 (cry 40', 1 (cam 50' and 1
@ 40' cored slab bridge.
11. List the type of equipment to be used to construct the project: Excavator, crane_
backhoe and bulldozer.
12. Describe the land use in the vicinity of this project: Site is surrounded by wooded land.
Page 4 of 11
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.
No previous project jurisdictional determination or permit history associated with site.
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: None anticipated.
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.
1. Wetland Impacts
Wetland Impact Area of Located within Distance to _
Site Number Type of Impact* Impact 100 year Floodplain** Nearest Stream Type of Wetland***
indicate on ma acres (es/no linear feet
Site 1 Fill <0.01 Yes Adjacent Emergent
* List each impact separately and identify temporary impacts, hnpacts include, but are not limited to: mechanized clearing, grading, till,
excavation, flooding, ditching/dramage, 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://w%Nw.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: <0.01 acre in the
project study area
Total area of wetland impact proposed: <0.01 acre
Page 5 of 11
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(indicate on
?)

Type of Impact*
Length of Impact
(linear feet)

Stream Name** Average Width of

Stream Before
Impact Perennial or
Intermittent?
(please
specify)
Site 1 Rip rap placed along streambank 34 ft north bank 33 ft south bank Smith Creek 46 feet Perennial

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 wail, 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
tixAiw.usF,,s.Qov. Several internet sites also allow direct download and printing of USGS maps (e.g., uww-topozonexom,
Nv%NA v.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 34 feet permanent fill
along north stream bank for stabilization and 33 feet of permanent fill on south stream bank
for stabilization.
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U. S.
Open Water Impact Area of
Name
Wate Type of Waterbody
Site Number Type of Impact* Impact e)
(if
applicable) (lake, pond, estuary, sound,
(indicate on ma acres bay, ocean, etc.)
Site 1 Fill <0.01 Smith Creek Perennial 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): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed.use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
Page 6 of 11
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.
The existing bridge is structurally deficient and must be replaced. All wetlands and surface
waters not affected by construction will be protected from unnecessau encroachment. No
staging of construction equipment or storage of construction supplies will be allowed in or near
wetlands or surface waters. Sedimentation and erosion control Best Management Practices and
Best Management Practices for Bridge Demolition and Removal will be enforced during project
construction. The bridge shall be removed such that debris will not fall into waters of the United
States during demolition. Continued coordination will occur with the contractor and the
Environmental Officer during construction to minimize impacts to waters of the United States
The design of the project has reduced the footprint of the project as much as possible to allow for
only the amount of fill necessary to safely complete the project.
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 replacwg_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, ncwetiands/strmgide. htmi.
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
Page 7 of 11
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.
Not Applicable.
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.u5lNi /index.htn,. 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 ® -1
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
Page 8 of 11
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 )?
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* uarpact
feet)
Multiplier
Required
1 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 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.
Not Applicable
Xl. 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.
Existing: 0.17 acre impervious surface of 0.58 acre total vroiect size._
Proposed: 0.26 acre impervious surface of 0.58 acre total project size.
Best Management Practices and other erosion control measures will be placed in a manner to
preclude sediment from leaving the site. All temporarily disturbed areas will berreve etg ated
immediately after construction.
XH. 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.
The project will not generate wastewater.
XDL Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Page 9 of 11
Is this an after-the-fact permit application?
Yes ? No
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).
?L (!?- ---:zc C• L(• v Z
Applicant/Agent's Signature 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
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
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
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes
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
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
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
Fax: [phone] Cumberland New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 10 of 11

US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
h and Wildlife Service / National N
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
[arine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
CAMA and NC Coastal Counties
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kernersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
Page 11 of 11