20070159 Ver 1_Application_20070129

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STATE OF NORTH CAROLINA
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DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPET
GOVERNOR
January 26, 2007
SECRETARY
SUBJECT: Davie County -Blaise Church Rd., SR 1345, WBS # 40841
Mr. John Thomas
US Army Corps of Engineers
6508 Falls of the Neuse Road, Suite 120
Raleigh, NC 27615-6814
Dear Mr. Thomas,
07~9P:~~9
In an effort to obtain the necessary permits for the subject road construction, we are providing a
pre-construction notification application with supporting documentation for the work on Blaise Church Rd.
in Davie County. This is a permit for defined streams with distinct stream banks. There will be 180 feet of
permanent stream impacts. We propose to build a new road to relocate Blaise Church Road to align with
the Walmart intersection at US 601. There will be 3 stream crossings of a tributary of Bear Creek. Stream
flow will be pumped around during construction. This will enable the work to be performed without
affecting the live stream. Rip rap will be placed along side of each end of the new pipe on the banks to
protect it from scour. No endangered species were found on 10/13/06. We believe this project can be
accomplished under Nationwide Permits 14 and 33.
By copy of this letter, we are also seeking approval from the NC Wildlife Resources Commission,
NC Department of Natural Resources -Water Quality, and the State Historic Preservation Office.
Therefore, we are submitting the enclosed material to them. If you have any questions, comments or need
additional information after reviewing this material, please contact me at [phone]. Thank you for
your cooperation in this matter.
Sincerely,
Diane K. Hampton, P.E.
Division Environmental Engineer
Enclosures
CF: Mr. Pat Ivey, P.E., Division Engineer
Mr. Mike Shaffner, P.E., Division Operations Engineer
Mr. John Rhyne, P.E., District II Engineer
Mr. Ron Linville, NCWRC
Mr. David Brook, SHPO
Ms. Sue Homewood (2 copies) DENR -Water Quality
Mr. John Hennessy (5 copies) DENR -Water Quality
Division of Highways • Division Nine • 375 Silas Creek Parkway, Winston-Salem, NC 27127
Telephone [phone] • Fax [phone] • Courier Box 13-12-04

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Name: MOCKSVILLE Location: 035.9223940° N 080.5920270° W
Date: 1/25/2007 Caption: Davie Co.
Scale: 1 inch equals 2000 feet Blaise Ch. Rd.

Office Use Only: Form Version April 2001
2U070159
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.
I. 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: NW-14, NW-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
Owner/Applicant Information
Name: NC Department of Transportation -Division 9
Mailing Address: 375 Silas Creek Parkway
Winston-Salem, NC 27127
Telephone Number: 336-703-6500 Fax Number:336-703-6693
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: Diane Hampton, PE, DEO
Company Affiliation: NCDOT -Division 9
Mailing Address: 375 Silas Creek Parkway
Winston-Salem NC 27127
Telephone Number: 336-703-6500 Fax Number: 336-703-6693
E-mail Address: dkhampton(c~dot.state.nc.us
Page 3 of 12

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
USAGE 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: Blaise Church Rd. SR 1345
2. T.I.P. Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Forsyth Nearest Town: Winston-Salem
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): Take I-40 west for 20 miles from
Winston-Salem to Mocksville. Take US 601 North, ~0 0.1 mile -turn left at the light at the
intersection to Walmart.
5. Site coordinates, if available (UTM or Lat/Long): 35.924° N 80.579° W
(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:
Suburban
Property size (acres):
N/A
8. Nearest body of water (stream/river/sound/ocean/lake): Unnamed trib. to Bear Creek
9. River Basin: Yadkin
(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/.)
Page 4 of 12

10. Describe the purpose of the proposed work: To install 3 pipes: 2 of them 48-inch diameter
corrugated metal pipes (CMP) and one 60-inch diameter CMP with all three of them 60 feet
m length.
11. List the type of equipment to be used to construct the project: standard pipe construction
equipment including a trackhoe
12. Describe the land use in the vicinity of this project: suburban, commercial use
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: N/A_
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
Page 5 of 12

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
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(es/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
N/A

*
Ltst 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: none
Total area of wetland impact proposed: none
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(indicate on ma)
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Im act Perennial or
Intermittent?
(leases eci
1 Permanent 60 UT to Bear Creek 3 Perennial
1 Rip rap on banks 6 each side UT to Bear Creek 3 Perennial
2 Permanent 60 UT to Bear Creek 4 Perennial
2 Rip rap on banks 6 each side UT to Bear Creek 4 Perennial
3 Permanent 60 UT to Bear Creek 2 Perennial
3 Rip rap on banks 6 each side UT to Bear Creek 2 Perennial

-~ L~si eacn impact separately and identity 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.uses.~ov. Several Internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 180 feet permanent
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 ma)

Type of Impact* Area of

Impact
(acres)
Name of Waterbod
(~ applicable) y Type of Waterbody

(lake, pond, estuary, sound,
ba ,ocean, etc.
N/A

' 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 N/A
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:
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.
Mocksville is experiencing_g~owth in the vicinity of Walmart and NCDOT needs to move
Blaise Ch. Road to align with the Walmart intersection to improve safet ay nd traffic flow. The
old road will be turned into a cul-de-sac. There will be 180 feet of stream impacts for the new
road.. The work will be constnzcted with the stream water beingpumped around. Each pipe
invert will be buried as required for aquatic life passage. All efforts to insure erosion control and
to minimize the placement of rip rap will be made. Natural materials will be used to stabilize the
banks where passible. Construction will be completed in a timely fashion to not upset the
natural and human communit}r.
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. html.
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.
To be determined by Co sr~ of Engineers
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):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount ofNon-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
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 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
(s ware feet) Multiplier Required
Miti ation
1 3
2 1.5
Total
{ Gone t extends out 3U feet perpend[cular 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.
N/A
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.
N/A
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.
N/A
XIII. 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 ^ 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).
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
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page I 1 of 12

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