20110792 Ver 1_Application_20110824

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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION _
BEVERLY PURDUE P. O. Box 25201, Raleigh, NC 27611-5202 EUGENE CONTI, JRH
GOVERNOR PHONE: [phone] SECRETARY
August 15, 2011
Mr. Monte Matthews
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office 110792
3331 Heritage Trade Drive, Suite 105
Wake. Forest, NC 27587
Subject: Nationwide Permit #14
SR 1345 (Beulah Church Road)
Surry County, North Carolina
Project Number: 11C.086120 (DWQ Permit Fee: $240)
Dear Mr. Matthews:
The NC Department of Transportation is scheduled to grade, drain, base and pave SR 1345,
Beulah Churt-h Road in Surry County. Total project length is approximately 0.96 miles. The
improved roadway will be widened from 16 feet to 20 feet with impervious surface area
increasing by 0.45 acres. This project will require the replacement of one wet pipe as shown
below.
Stream Impacts:
W ?bji.
Shoo
!Number r ?T, - 6k'
?E
bR e Srze.,._ Ar LiA'W`zA
tProposed
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IIm acts ft , !f. Y 3N]1a i
Temporery
?Dewaterm ; ft i N'?NPR MvF':.
Tot pa
,.at thrs-Stahon
13+37 40'x 60" 60'x 60" 20 40 80

Permanent FWMprap Impacts = 40 feet Total project Impacts = 80 feet
The replacement of the above noted wet pipe will require temporary dewatering. An impervious
sandbag dike will be constructed upstream of the existing culvert to create a shall pool. Clean
water will temporarily be pumped around the construction areas and will be discharged
downstream. Any dirty water located inside of the construction areas will be pumped into a silt
bag if necessary. Once the new pipes are in place, the impervious dikes will be removed and
preconstruction streambed elevations will be restored.
P. O. Box 250, N. WH.KESEORO, NC 28659
PHONE [phone] Fax [phone]
Or
WATF9OG
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JAI'
Office Use Only
Corps action ID no.
DWQ project no.
Forth Version 1.3 Dec 10 2008
Pre-Construction Notification. PCN Form
A. Applicant Information
1. Processing
I a. Type(s) of approval sought from the
Corps: ® Section 404 Permit ? Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
I c. Has the NWP or GP number been verified by the Corps? ? Yes ® No
Id. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water-Quality Certification - Express - Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
? Yes ®No For the record only for Corps Permit:

? Yes ® No
If. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes ? No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 In
below. ? Yes ®No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: SR 1345, Beulah Church Road
2b. County: Sury
2c. Nearest municipality / town: Beulah
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no: 110.086120
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address: 801 Statesville Road
3e. City, state, zip: North Wilkesboro, NC 28659
3f. Telephone no.: 336-903-9202
3g. Fax no.: 336-667-4549
3h. Email address: [e-mail]
Page 1 of 10
PCN Forth - Version 1.3 December 10, 2008 Version
4. Applicant Inforrnation (if different from owner)
4a. Applicant is: ? Agent ? Gifier, specify:
4b. Name:
4c. Business name
(d applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
S. Agent/Consultant Information (if applicable)
5a. Name:
5b. Business name
(d applicable):
-
ac. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 10
PCN Forth - Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax PIN or parcel ID):

1b. Site coordinates (in decimal degrees):
36.49078 Longitude: - 80.80135
Latitude:
(DD.DODDDD) (-DD.DDDDDD)
le. Property size: 5.9 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project: UT to Wood Fork
2b. Water Quality Classification of nearest receiving water: C
2c. River basin: Yadkin
3. Project Description
3a. Describe the ex!-?ng conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Unpaved road in a rural area.
3b. List the total estimated acreage of all existing wetlands on the property:
0 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
60 linear feet
3d. Explain the purpose of the proposed project:
Upgrade roadway.
3e. Describe the overall project in detail, including the type of equipment to be used:
See attached cover letter.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
Comments:
? Yes N No ? Unknown
4b. If the Corps made the jurisdictional determination, what type
of determination was made? ? Preliminary ? Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Agency/Consultant Company:
Other
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (ncluding all prior phases) in the past? ? Yes N No ? Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ? Yes N No
6b. If yes, explain.
Page 3 of 10
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
I a. Which sections were completed below for your project (check all that apply):
? Wetlands ® Streams - tributaries ? Buffers
? Open Waters ? Pond Construction

2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary
? Yes ? Corps
W1 ? P ? T ? No ? DWQ
? Yes ? Corps
W2 ? P ? T _ ? No . ? DWQ
? Yes ? Corps
W3 ? PEI T ? No ? DWQ
? Yes ? Corps
W4 ? P ? T ? No ? DWQ
? Yes ? Corps
W5 ? P ? T ? No ? DWQ
? Yes ? Corps
W6 ? P ? T ? No ? DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average
t Impact
length
number - (PER) or (Corps - 404, 10 ream
s
width (linear
Permanent (P) or intermittent DWQ - non-404, feet)
Temporary M (INT)? other) (feet)
81 ®P ®T Piping, Riprap & UT Wood Fork ® PER
? INT ® Corps
® DWQ 2 80
Dewatering
? PER ? Corps
S2 ? P ? T .
? INT ? DWQ
? PER ? Corps
S3 ? P ? T ? 1NT ? DWQ
? PER ? Corps
S4 ? P ? T ? INT ? DWQ
? PER ? Corps
S5 ? P ? T ? INT_ ? DWQ
? PER ? Corps
S6 ? P ? T ? INT ? DWQ
31L Total stream and tributary impacts 80
3i. Comments: 40 linear feet of the impacts are temporary
Page 4 of 10
PCN Form - Version 1.3 December 10, 2008 Version
4. Open Water Impacts
If there are proposed impacts to lakes, ponds,
estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (f applicable)
Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Temporary
Ot ?P?T
02 ?P?T

03 ?P?T

04 ?P?T
4f. Total open water impacts
4g. Comments:

6. Pond or Lake Construction
If and or lake construction proposed, then complete the chart belo •:
5e
5a. 5b. 5c. .
5d.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
X Total
5g. Comments: N/A

5h. Is a dam high hazard permit required? ? Yes ®No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):

5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a. ? Neuse ? Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number-
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary impact reg- fired?
?Y
B1 ?P?T. No
o
[--]
? Yes
B2 ? PEI T ? No
? Yes
B3 ? P ? T ? No
6h. Total buffer impacts
6i. Comments:
Page 5 of 10
PCN Form - Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
I a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The pipe length is the minimum needed to improve roadway.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
All appropriate BMPs will be used during construction
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State? ? Yes ? No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation option will be used for this
project?
- ? Mitigation bank
? Payment to irt-lieu fee program

? Penni[tee Responsible' Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Pennittee Responsible Mitigation Plan
5a. If using a permitfee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form - Version 1.3 December 10, 2008 Version
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) -required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in lieu fee fund).
6h. Comments:
Page 7 of 10
PCN Forth - Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan

I a. Does the project include or is it adjacent to protected riparian buffers identified
within one of the NC Riparian Buffer Protection Rules? ? Yes ® No
1b. If yes, then is a diffuse flow plan included? If no, explain why.
? Yes ? No
Comments:
2. Stormwater Ma ement Plan

2a. What is the overall percent imperviousness of this project? %
2b. Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Secondary Road Project
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stonmwater Program
? DWQ 401 Unit
3. Certified Local Government Stonmwater Review

3a. In which local governments jurisdiction is this project?
? Phase 11
3b. Which of the following locally-implemented stormwater management programs ? NSW
USMP
El
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stonmwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review

? Coastal counties

4a.
Which of the following state-implemented stormwater management programs apply
(check all that apply): ? HQW
? ORW
? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached?
? Yes ? No
5. DWQ 401 Unit Stormwater Review

5a . Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No
5b . Have all of the 401 Unit submittal requirements been met? ? Yes ? No
Page 8 of 10
PCN Form - Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
I a. Does the project involve an expenditure of public (federal/state/locao funds or the ® Yes ? No
use of public (federaVstate) land?
1b. If you answered 'yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ? Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
I c. If you answered 'yes" to the above, has the document review been finalized by the
State Clearing House? (if so, attach a copy of the NEPA or SEPA final approval El Yes El No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Is,tated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s): -
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ®No
additional development, which could impact nearby downstream water qualify?.
3b. If you answered Nee to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. 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.
N/A
Page 9 of 10
PCN Form - Version 1.3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or El Yes ®No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ®No
impacts?
? Raleigh
5c. If yes, indicate the USFWS Field Offioe,you have contacted.
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
GIS and visual observation
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
WRC will comment
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation ? Yes ®No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ? Yes ®No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? ncfloodmaps
J. Heath Slaughter 8/15/11

Applicant/Agent's Printed Name ApplicanUAgent's gnature
(Ager fs nature is valid only if an auth ' lion letter from the applicant Date
is ovided.
Page 10 of 10
PCN Form - Version 1.3 December 10, 2008 Version
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PROJECT.- IIC.086024
ROAD: SR 1345 "BEULAH CHURCH RD."
COUNTY: SURRY
TYPE. WET PIPE SURVEY
PLAN SCALE: 1" = 60'
SHEET IOF I
DATE: JUNE 222011
STREAM NAME: UNNAMED TRIBUTARY TO
"BEAVERDAM CREEK"
RATING:
3' AVERAGE STREAM WIDTH
w
Z
a
PIPE TO BE LAID ON A 112° SKEW
WITH I.0% FALL
1005
CENTERLINE 714
PROPOSED R/W i`V
F
PROPOSED EDGE OF PAVEMENT
EXISTING EDGE OF ROADWAY - - - - - -
--------
NEW PIPE ?-
EXISTING PIPE - J
r-1
EXISTING PIPE SIZE: 60" X 40' CMP
NEW PIPE SIZE: 60" X 60' CSPA
1003
998
PROPOSED 1.0% SLOPE
will be installed as needed DRAWN BY: J. WOOD % 0 ,,. 5 10 15 20 25 30 35 40 -45 50 55 60
Temporary erosion control SURVEY DATE: 06-22-2011
devices are not shown, but CONDUCTED BY: JW,JB

R

PROJECT: IIC,086024 CENTERLINE 70
ROAD: SR 1345 "BEULAH CHURCH RD." PROPOSED R/W
000NTY: SURRY
TYPE: WET PIPE SURVEY PROPOSED EDGE OF PAVEMENT
PLAN SCALE: I" = 60' EXISTING EDGE OF ROADWAY - - - - - -
SHEET I OF I NEW PIPE i--?
DATE: JUNE 22, 2011 EXISTING PIPE=-J
STREAM NAME: UNNAMED TRIBUTARY TO
"BEAVERDAM CREEK"
RATING:
3' AVERAGE STREAM WIDTH
Place Matting for Erosion Control
on Slopes Adjacent to Permitted
Wetlands as Work Allows.
IMPERVIOUS
DIKE
w
Z y

+

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1{0101 9,.?J a .. f?.l Pte- ?
j--
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T..,_.., R.0 8:4 CM1.A T A .W
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vwi.

I001M T..,..n R" 9.Ibr R._ Tn.-B_ V
10"(01 R" R.. bb R.l:r T... T--A u
PIPE TO BE LAID ON A 1120 SKEW
WITH 1,07 FALL
EXISTING HIPE SIZE: 60" X 40' CMP
NEW PIPE SIZE: 60" X 60' CSPA
IMPERVIOUS
DIKE
UNNAMED TRIBUTARY
"BEAVERDAM CREEK"
SPECIAL
STILLING
BASIN
DEWATERING WILL BE STOCKPILE AREA IN ROADWAY
PERFORMED ACCORDING TO WITH SILT FENCE LOCATED ON
BMP FOR PUMPING OPERATIONS LOWER SIDE
INSTALL PIPE(S) IN JURISDICTIONAL AREAS ACCORDING TO
NC DOT BEST MANAGEMENT PRACTICES (4.2) FOR
CONSTRUCTION AND MAINTENANCE ACTIVITIES MANUAL.
SURVEY DATE: 06-22-2011
CONDUCTED BY:JW.JB
DRAWN BY: J. WOOD