20031074 Ver 1_Complete File_20050225

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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. KlirperyFSP?lDirector
H. Sullins,
DWQ Project No.: 23 - /074 County:
Applicant: ,y??eT vi5ro? / Z
Project Name: -
--I Z:5-, 5 z /
Date of Issuance of 401 Water Quality Certification: a/z O
Certificate of Completion
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Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401/Wetiands Unit, North
Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621. This form may be
returned to DWQ by the applicant, the applicant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Applicant's Certification
I, ld?' _, hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plan a specifications, and other supporting materials.
Signature: Date: D
Agent's Certification
hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature:

Date:
if this project was designed by a Certified Professional
1 , as a duly registered Professional (i.e.,
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to
observe (periodically, weekly, full time) the construction of the project, for the Permittee hereby state that, to
the best of my abilities, due care and diligence was used in the observation of the construction such that the
construction was observed to be built within substantial compliance and intent of the 401 Water Quality
Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature:
Registration No.
Date
AAA
N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (httpl/h2o.enr.state.nc.uslncwetlands
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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Coleen H. Sullins, Deputy Director
Division of Water Quality
September 19, 2003
Lincoln County
DWQ Project No. 031074
SR 1354 (Bridge No. 25)
APPROVAL of 401 Water Quality Certification with Additional Conditions
Mr. Michael L. Holder, P.E.
Division Engineer
N C Department of Transportation
Post Office Box 47
Shelby, North Carolina 28151
Dear Mr. Holder:
You have our approval, in accordance with the attached conditions and those listed below, to permanently impact 94
linear feet (44 feet of new box culvert, 50 feet of flood plain bench and 30 feet of riprap at each wing wall) and
temporarily impact 70 linear feet of Lick Run Creek) in order to replace the failing bridge on NCSR 1354 in Lincoln
County. The project must be constructed in accordance with your application dated August 15, 2003 (received
August 22, 2003), including the environmental commitments made in the application letter. After reviewing your
application, we have decided that this fill is covered by General Water Quality Certification Nos. 3404 and 3366,
corresponding to the U.S. Army Corps of Engineers Nationwide Permit Numbers 14 and 33. In addition, you must
acquire any other federal, state or local permits before you proceed with your project including (but not limited to)
Sediment and Erosion Control, Non-Discharge and Water Supply Watershed regulations. This approval will expire
with the accompanying 404 permit unless otherwise specified in the Water Quality Certification.
This approval is valid solely for the purpose and design described in your application (unless modified below).
Should your project change, you must notify the DWQ in writing and submit a new application. If the property is
sold, the new owner must be given a copy of this Certification and approval letter, and is thereby responsible for
complying with all the conditions. If total wetland fills for this project (now or in the future) exceed one acre, or of
total impacts to streams (now or in the future) exceed 150 linear feet, compensatory mitigation may be required as
described in 15A NCAC 2H .0506 (h) (6) and (7). For this approval to be valid, you must follow the conditions
listed in the attached certification and any additional conditions listed below.
1. NCDOT shall use Best Management Practices for the Protection of Surface Waters (NCDOT March 1997).
These measures must be implemented prior to any ground disturbing activities to minimize impacts to
downstream aquatic resources. Temporary or permanent herbaceous vegetation should be planted on all bare. soil
within 15 days of ground disturbing activities to provide long-term erosion control. NCDOT is encouraged to
use onsite vegetation and materials for streambank stabilization when practicable.
2. As two box culverts will be installed, the stream should only flow through one box culvert during normal flow
conditions and through the other box culvert above bankfull conditions. The proposed floodplain benches should
be installed to restore natural channel dimensions upon completion of the project. The benches should be
constructed of natural materials for bench stability.
3. Riparian vegetation must be reestablished within the construction limits of the project by the end of the growing
season following completion of construction.
4. Culverts that are less than 48-inch in diameter should be buried to a depth equal to or greater than 20% of their
size to allow for aquatic life passage. Culverts that are 48-inch in diameter or larger should be buried at least 12
inches below the stream bottom to allow natural stream bottom material to become established in the culvert
following installation and to provide aquatic life passage during periods of low flow. These measurements must
be based on natural thalweg depths.
1617 Mail Service Center Raleigh, N.C. 27699-1617 Telephone: [phone] Fax: [phone] Customer Service: 1-877/623-6748
5. The dimension, pattern and profile of the stream above and below the crossing should not be modified by
widening the stream channel or reducing the depth of the stream. Disturbed floodplains and streams should be
restored to natural geomorphic conditions.
6. Any riprap used must not interfere with thalweg performance and aquatic life passage during low flow
conditions.
7. If concrete is used, work must be accomplished so the wet concrete does not contact the stream water. This will
lessen the change of altering the stream's water chemistry and causing a fish kill.
8. Heavy equipment must be operated from the banks rather than in the stream channel in order to minimize
sedimentation and reduce the likelihood of introducing other pollutants into the stream.
9. All mechanized equipment operated near surface waters must be regularly inspected and maintained to prevent
contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic materials.
10. The presence of equipment in the channels must be minimized. Under no circumstances must rock, sand or other
materials be dredged from the wetted stream channel under authorization of this permit, except in the immediate
vicinity of the culverts.
11. All work shall be performed during low flow conditions.
12. Upon completion of the project, the NCDOT shall complete and return the enclosed "Certificate of Completion"
form to notify NCDWQ when all work included in the §401 Certification has been completed. The responsible
party shall complete the attached form and return it to the 401/Wetlands Unit of the NC Division of Water
Quality upon completion of the project. NCDOT is strongly advised to send in photographs upstream and
downstream of each structure to document correct installation.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must
act within 60 days of the date that you receive this letter. To ask for a. hearing, send a written petition, which
conforms to Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, 6714
Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its conditions are final and binding unless you
ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you
have any questions, please telephone Ms. Cynthia Van Der Wiele at 919.733.5715 or Mr. Mike Parker of the
Asheville Regional Office at 828.251.6208.
Attachment
cc: Wilmington District Corps of Engineers
Trish Simon, Division 12, DEO
Neil Trivette, Roadside Environmental
Steve Lund, USACE Asheville Field Office
Wetlands/401 Unit
Mike Parker, NCDWQ Asheville Regional Office
Central Files
Sincerely,
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Coleen H. Sullins, Deputy Director
Division of Water Quality
August 28, 2003
Lincoln County
DWQ Project No. 031074
SR 1354 (Bridge No. 25)
APPROVAL of 401 Water Quality Certification with Additional Conditions
Mr. Michael L. Holder, P.E.
Division Engineer
N C Department of Transportation
Post Office Box 47
Shelby, North Carolina 28151
Dear Mr. Holder:
You have our approval, in accordance with the attached conditions and those listed below, to permanently impact 94
linear feet (44 feet of new box culvert, 50 feet of flood plain bench and 30 feet of riprap at each wing wall) and
temporarily impact 70 linear feet of Lick Run Creek) in order to replace the failing bridge on NCSR 1354 in Lincoln
County. The project must be constructed in accordance with your application dated August 15, 2003 (received
August 22, 2003), including the environmental commitments made in the application letter. After reviewing your
application, we have decided that this fill is covered by General Water Quality Certification Nos. 3404 and 3366,
corresponding to the U.S. Army Corps of Engineers Nationwide Permit Numbers 14 and 33. In addition, you must
acquire any other federal, state or local permits before you proceed with your project including (but not limited to)
Sediment and. Erosion Control, Non-Discharge and Water Supply Watershed regulations. This approval will expire
with the accompanying 404 permit unless otherwise specified in the Water Quality Certification.
This approval is valid solely for the purpose and design described in your application (unless modified below).
Should your project change, you must notify the DWQ in writing and submit a new application. If the property is
sold, the new owner must be given a copy of this Certification and approval letter, and is thereby responsible for
complying with all the conditions. If total wetland fills for this project (now or in the future) exceed one acre, or of
total impacts to streams (now or in the future) exceed 150 linear feet, compensatory mitigation may be required as
described in 15A NCAC 2H .0506 (h) (6) and (7). For this approval to be valid, you must follow the conditions
listed in the attached certification and any additional conditions listed below.
1. NCDOT shall use Best Management Practices for the Protection of Surface Waters (NCDOT March 1997).
These measures must be implemented prior to any ground disturbing activities to minimise impacts to
downstream aquatic resources. Temporary or permanent herbaceous vegetation should be planted on all bare soil
within 15 days of ground disturbing activities to provide long-term erosion control. NCDOT is encouraged to
use onsite vegetation and materials for streambank stabilization when practicable.
2. As two box culverts will be installed, the stream should only flow through one box culvert during normal flow
conditions and through the other box culvert above bankfull conditions. The proposed floodplain benches should
be installed to restore natural channel dimensions upon completion of the project. The benches should be
constructed of natural materials for bench stability.
3. Riparian vegetation must be reestablished within the construction limits of the project by the end of the growing
season following completion of construction.
4. Culverts that are less than 48-inch in diameter should be buried to a depth equal to or greater than 20% of their
size to allow for aquatic life passage. Culverts that are 48-inch in diameter or larger should be buried at least 12
inches below the stream bottom to allow natural stream bottom material to become established in the culvert
following installation and to provide aquatic life passage during periods of low flow. These measurements must
be based on natural thalweg depths.
1617 Mail Service Center Raleigh, N.C. 27699-1617 Telephone: [phone] Fax: [phone] Customer Service: 1-877/623-6748
5. The dimension, pattern and profile of the stream above and below the crossing should not be modified by
widening the stream channel or reducing the depth of the stream. Disturbed floodplains and streams should be
restored to natural geomorphic conditions.
6. Any riprap used must not interfere with thalweg performance and aquatic life passage during low flow
conditions.
7. If concrete is used, work must be accomplished so the wet concrete does not contact the stream water. This will
lessen the change of altering the stream's water chemistry and causing a fish kill.
8. Heavy equipment must be operated from the banks rather than in the stream channel in order to minimise
sedimentation and reduce the likelihood of introducing other pollutants into the stream.
9. All mechanized equipment operated near surface waters must be regularly inspected and maintained to prevent
contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic materials.
10. The presence of equipment in the channels must be minimized. Under no circumstances must rock, sand or other
materials be dredged from the wetted stream channel under authorization of this permit, except in the immediate
vicinity of the culverts.
11. All work shall be performed during low flow conditions.
12. Upon completion of the project, the NCDOT shall complete and return the enclosed "Certificate of Completion"
form to notify NCDWQ when all work included in the §401 Certification has been completed. The responsible
party shall complete the attached form and return it to the 401/Wetlands Unit of the NC Division of Water
Quality upon completion of the project. NCDOT is strongly advised to send in photographs upstream and
downstream of each structure to document correct installation.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must
act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition, which
conforms to Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, 6714
Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its conditions are final and binding unless you
ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you
have any questions, please telephone Ms. Cynthia Van Der Wiele at 919.733.5715 or Mr. Mike Parker of the
Asheville Regional Office at 828.251.6208.
Sincerely,
&k, P.
Attachment
cc: Wilmington District Corps of Engineers
Trish Simon, Division 12, DEO
Neil Trivette, Roadside Environmental
Steve Lund, USACE Asheville Field Office
Wetlands/401 Unit
Mike Parker, NCDWQ Asheville Regional Office
Central Files
MEMORANDUM
TO: John Dorney Regional Contact:
Non-Discharge Branch WQ Supervisor:
Date:
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
Facility Name NCDOT - SR 1354 County LINCOLN
Project Number 03 1074 County2
Recvd From APP Region Mooresville
Received Date 8/22/03 Recvd By Region
Project Type
Certificates Stream Stream Impacts (ft.)
Permit Wetland Wetland Wetland Stream Class Acres Feet
Type Type Impact Score Index Prim. Supp. Basin Req. Req. ME
14 77_O -r 94.oo ?-
Mitigation Wetland
MitigationType Type Acres Feet
Is Wetland Rating Sheet Attached? 0 Y 0 N Did you request more info? 0 Y0 N
Have Project Changes/Conditions Been Discussed With Applicant? 0 Y 0 N
Is Mitigation required? 0 Y 0 N
Provided by Region: Latitude (ddmmss) 352927
Recommendation: 0 Issue 0 Issue/fond 0 Deny
Longitude (ddmmss) 810949
Comments:
DOT is groposina to replace the existing bridge No. 25 on NCSR 1354 with a double box culvert.
The impacts will consist of 44 feet of new box culvert and 50 feet of new floodplain bench above and
below the culvert.
cc: Regional Office
Central Office Page Number 1

STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P.O. Box 25201, RALEIGH, N.C. 27611-52o1 LYNDO TIPPETT
GOVERNOR SECRETARY
P.O. BOX 47, 1710 East Marion Street
Shelby, N. C. 28151-0047
August 15, 2003 VVEj ?ND81M1 Rol p
Mr. Steve Lund - NCDOT Projects l?
US Army Corp of Engineers RUG "fit ?i1
C' 2Ut)3
Asheville Regulatory Field Office
?TCn
151 Patton Avenue, Room 208 0 314 7 4 QUALITYSECnON
Asheville, N. C. 28801-5006
Dear Mr. Lund:
The North Carolina Department of Transportation, Division of I3'ighways, request the issuance of
a Section 404 Permit, Nationwide Permit #14, Road Crossings and #33, Temporary Construction,
Access, and Dewatering.
COUNTY: Lincoln
LOCATION: SR 1354, east of Lincolnton
STREAM: Lick Run Creek, Class C Waters (from source to Leepers Creek),
Catawba River Basin
PROTECT DESCRIPTION: The project consists of the replacement of a 20' wide x 20' long
structurally deficient bridge with a 44-foot long, double (12' x 8') concrete box culvert. Fifteen
feet of riprap will be used at the inlet and outlet for structure protection and stabilization. A
stream profile was established by measuring the thalweg elevations at various points upstream and
downstream and of the proposed pipe. The proposed culvert will be buried one foot below the
existing streambed elevation based upon the established thalweg profile. The proposed culvert
gradient has been calculated to be at a 0.5% slope; therefore, stream destabilization
(headcutting/downcutting) is not anticipated. A linear temporary cofferdam will be utilized to
manage the watercourse during the phased construction of the double culvert. Upon project
completion, the area impacted by the temporary cofferdam at the inlet and outlet of the culvert
will be reconstructed as floodplain benches to maintain natural channel dimensions and to direct
low flow through only one cell of the double culvert. I have enclosed a PCN application, a sketch
of activities, and location maps relative to the project.
??L r? rr„ rr
Mr. Steve Lund
Bridge #25 Replacement, SR 1354
August 15, 2003 - Page 2
The proposed project is located in Class C waters and SR 1354 is not classified a rural or urban
arterial. Hazardous spill basins are not required. Enclosed is the NCDOT hazardous spill basin
checklist.
A review of the Natural Heritage information for the threatened species listed for Lincoln County,
the dwarf-f lowered heartleaf (Hexasiylis naniflora) and Michaux's sumac (Rhus michauxii),
revealed no known sites in the vicinity of the project area. A survey for these species was
conducted on August 7, 2003 in the vicinity of the project. It was determined that this species
was not located in the project area, therefore, no impact on this species is anticipated. A review
of the available information from the National Register of Historic Places was also conducted. It
is anticipated that no historic sites will be affected by the proposed project.
Your earliest consideration for this request would be greatly appreciated. Should you have any
questions, please call me at 704480-9020.
Respectfully yours,
M.L. Holder, RE,
Division Engineer
Twelfth Division
BY: _ \
Trish Simon
Division 12 Environmental Officer
Enclosures
cc: Mr. Michael L. Holder, P.E., Division Engineer
Mr. Dan Holderman, P.E., Division Bridge Engineer
Mr. Ron Linville, N.C. Wildlife Resources Commission
Mr. Brian Cole, U.S. Fish & Wildlife Service
Mr. Mike Parker, DENR, DWQ, Asheville Regional Office
Mr. John Domey, DENR, DWQ, 401, Wetlands Unit
Mr. Neil Trivette, Roadside Environmental Field Engineer
File
Office Use Only: Form Version October 2001
031074
USAGE 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: Nationwide Permit #14.,_#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: ?
IL Applicant Information
1. Owner/Applicant Information
Name: Mike Holder NCDOT
Mailing Address: P.O. Box 47
Shelby, NC 28151
Telephone Number: 704-480-9020 Fax Number: 704-480-5401
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: Trish Simon
Company Affiliation: NCDOT
Mailing Address: P.O. Box 47
Shelby, NC 28151
Telephone Number: 704480-9044 Fax Number: 704-480-5401
E-mail Address: [e-mail]
Page I of 8
IM 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 I 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: Replacement of Bridge #25. SR 1354, Lincoln County.
2. T.I.P. Project Number or State Project Number (NCDOT Only): 12B.205512
3. Property Identification Number (Tax PIN): NCDOT Right of way
4. Location
County: Lincoln Nearest Town: Boger City
Subdivision name (include phase/lot number): NA
Directions to site (include road numbers, landmarks, etc.): Hwy 27 east from Lincolnton.
Turn left onto SR 1354 and proceed 1.5 miles to Bridge #25.
5. Site coordinates, if available (UTM or Lat/Long): 35°29'27'N/81°09'49W
(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:
Bridge on paved secondary road
7. Property size (acres): 0.20 acres NCDOT right of way
8. Nearest body of water (stream/river/sound/ocean/lake): Lick Run Creek (from source to
Leepers Creek). Class C Waters
9. River Basin: Catawba
(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/maDs/.)
Page 2 of 8
10. Describe the purpose of the proposed work: The project consists of replacing a struovally
deficient bridge with 44-foot long. 12'x 8'double, concrete box culvert with associated slope
ripran for structure stabilization.
11. List the type of equipment to be used to construct the project: A trackhoe and cran
e
will be used for culvert construction.
12. Describe the land use in the vicinity of this project: The surrounding, area is wooded and
agricultural.
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.
NA
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application:
None anticipated.
VL 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: NONE
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100 year Floodplain**
61wno) Distance to
Nearest Stream
(linear feet
Type of Wetland***

Page 3 of 8
" 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
(FZRIvl), 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: 0
2. Stream Impacts, including all intermittent and perennial streams
Stream
Impact Site Length of Average Width Perennial or
Number Type of Impact* Impact Stream Name** of Stream Intermittent?
(indicate on (linear feet) Before Impact (please specify)
ma
1 Concrete Box Culvert 44 feet Lick Run Creek 10 feet Perennial
Placement of riprap on 15 feet
(inlet)
1 shwunbank for structure 15 feet
protection (outlet)
Floodplain bench (to maintain
1 channel dimensions & direct 50 feet "
main flow to one cell)
I Linear Temporary Cofferdam 70 feet "
List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip MA
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
R " StrEazn 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.gov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: Total Permanent Impacts
from floodplain bench construction and box culvert = 94 feet (15 feet of streambank riprap
impacts contained within this 94 feet): Total temporary impacts = 70 feet.
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U. S. NO OPEN WATER RViPACTS
Open Water Impact Area of Name of Waterbod
y Type of Waterbody
Site Number Type of Impact* Impact
(if applicable) (lake, pond, estuary, sound,
(indicate on map) (acres) bay, ocean, etc.

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
Page 4 of 8
4. Pond Creation NO 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:
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 west end bents of the bridge are settling/failing and the bridge must be replaced as soon as
possible. Replacement of the bridge with a concrete box culvert requires a lesser amount of
engineering design work and is a lower cost alternative; therefore, the box culvert installation
allows for expedited replacement of the failing bridge.
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
Page 5 of 8
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strm.gide.html.
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 (acreagellinear 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.
EVIPACTS < 150 FEET• MITIGATION NOT ANTICIPATED
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.ustwrD/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 of Non-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
Page 6 of 8
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 )?
Yes El 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

(sqi= fed)
M ReqWxW
Mfigation
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 .0250.
NA
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.
No additional impervious surface is proposed in this project.
XIEL 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.
NA
XM. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Page 7 of 8
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).

f ?? 3
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 8 of 8
Upstream of Bridge #25
Downstream of Bridge #25
Bridge #25, SR 1354
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Location: 035° 29'12.9' N 081 ° 09'502' W
Caption: Bridge #25 Replacement, SR 1354, Lick Run Creek, Class C
Waters, Catawba River Basin
Copyright (C) 1997, Wptech, Inc.
NCDOT NEWTON BRIDGE 8828 466 5525 08/05 '03 14:59 NO.209 04/12

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NCDOT NEWTON BRIDGE 8828 466 5525 08/05 103 15:00 NO.209 09/12
NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division: County: Project ID: 126.Zo53'1-r-
River Basin: Bridge No: 025
Route: -5O /35* Stream: lLz.-,J --
Water Quality Criteria:
Yes No
Stream Crossing Blue Line On USGS T r
ORW r.- rv-1
WSI r r
WS II,1H'OR IV, Crossing Within 0.5mi of W.S. Critical Area r r?
Roadway Criteria:
Route Designation-
Yes No
Arterial Urban. r rp"'
Arterial Rural r r-e`?
Additional Site Information:
Yes No
Is a Hazardous Spill Basin Required? r N1,11-
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997).
aY
PAYMENT
RECEIVED
STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GovEmoR SECRETARY
031074
MEMO TO: John Dorney, DENR/DWQ/401/Wetlands Unit
FROM: Trish Simon, Division 12 Environmental Supervisor
DATE: August 15, 2003
SUBJECT: Pre-Construction Notification/401 Automated Payment
*14*9
81401GROIlp
4UG 12
"SEMON
Enclosed are seven copies of a pre-construction notification for a NCDOT project in
Lincoln County for your review.
Project information for the 401 Automated Payment Procedure
• Work order number: 150464-55120005-12B.205512-3855-55025
• TIP #: NA
• Project Category: $200.00 Fee
is
Post Office Box 47 Shelby, North Carolina 28151-0047