20100589 Ver 1_Application_20100809

STATE OF NORTH CAROLINA
BEVERLY EAVES PERDUE
GOVERNOR
July 21, 2010
North Carolina Division of Water Quality
Attn: Ms. Polly Lespinasse
401 Wetlands Certification Unit
2321 Crabtree Boulevard .
Raleigh, NC 27604-2260
DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS
fU-OS84
Subject: Union County-Proposed Pipe Replacement Project (Revision)
SR 1627 (New Salem Road) WBS Element No. 10B.100411
Dear Ms. Lespinasse:
The North Carolina Department of Transportation (NCDOT) proposes to replace two 24-
inch by 40-foot long reinforced concrete pipes (RCP) located on SR 1627 (New Salem
Road) on an unnamed tributary to Richardson Creek with a single line of 87-inch by 63-
inch corrugated metal pipe arched (CMPA), 70 feet in length. The purpose of the
proposed project is to repair the failed roadway at this crossing and add enough shoulder
to improve motorist safety.
Richardson Creek is classified as a Class C water and is located in the Yadkin River
Basin, Hydrologic Unit 03040105. The total length of permanent stream impacts for this
project is 15 linear feet.
The NCDOT anticipates that this project will be authorized under a Section 404
Nationwide Permit No. 14 and we are requesting authorization from the North Carolina
Division of Water Quality to utilize the corresponding 401 Water Quality Certification
GC3704 based upon the enclosed information.
If you have any questions or need any additional information regarding this request,
please contact Mr. Larry Thompson, Division Environmental Supervisor, at (704) 982-
0101. Thank you for your assistance with this request.
Sincerely,
Barry S. Moose, PE
Division Engineer
0
716 West Main Street, Albemarle, NC 28001 • [phone] • Fax [phone]
EUGENE A. CONTI, JR.
SECRETARY
Section A. Applicant Information, continued
4. Applicant Information (if different from owner)
4a. Applicant is: ® Agent ? Other, specify:
4b. Name: Barry S. Moose, PE
4c. Business name
(if applicable): NC Department of Transportation
4d. Street address: 716 W. Main Street
4e. City, state, zip: Albemarle, NC 28001
4f. Telephone no.: 704-982-0101
4g. Fax no.: 704-982-3146
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 12
PCN Form - November 2008 Version
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
1 b. Site coordinates (in decimal degrees): 35.090744'N - 80.415886'W
1 c. Property size: 0.10 (maintained ROW area) acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to UT to Richardson Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: C
2c. River basin: Yadkin
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The general land use adjacent to the project area is rural residential. This water body is an unnamed tributary to
Richardson Creek and has a wooded buffer upstream and partially buffered downstream (adjacent to a single family
residence).
3b. List the total estimated acreage of all existing wetlands on the property:
0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
This is a linear tansportation crossing and the stream length that NCDOT will be working in will be 80 linear feet or less.
3d. Explain the purpose of the proposed project:
There are two rusted bottom 24-inch by 40-foot long reinforced concrete pipe at this crossing which is causing the
roadway to fail. NCDOT proposes to replace the failing pipe with a single line of corrugated metal pipe (arched) 87-inch
by 63-inch by 70-feet in length.
3e. Describe the overall project in detail, including the type of equipment to be used:
Appropriate erosion control measures will be installed and the site will be dewatered, as needed (stream is currently dry),
during the pipe removal and pipe replacement process. The equipment that is required is limited to: a dewatering pump,
trackhoe, dumptrucks, vibratory roller, motor grader and paving equipment.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property / ? Yes ® No ? Unknown
project (including all prior phases) in the past?
4b. If the Corps made the jurisdictional determination, what type ? Preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): 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 ? yes ®No ? Unknown
this project (including all prior phases) in the past?
51b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 3 of 12
PCN Form - Version 1.0 November 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1a. 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 Type of wetland Forested (Corps - 404, Area of impact (acres)
Permanent (P) or impact (if known) DWQ - non-404, other)
Temporary T
W1 ? P ? T ? Yes ? No ? Corps
? DWQ
W2 ? P ? T ? Yes ? No ? Corps
? DWQ
W3 ? P ? T ? Yes ? No ? Corps
? DWQ
W4 ? P ? T ? Yes ? No ? Corps
? DWQ
W5 ? P ? T ? Yes ? No ? Corps
? DWQ
W6 ? P ? T ? Yes ? No ? Corps
? 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. 31b. C. 3d. 3e. 3f.
Stream impact Type of Stream name Perennial (PER) or Average stream width (feet) Impact
number- impact intermittent(INT)? length
(linear feet)
Permanent (P) or
Temporary (T)

Pipe
Installatio

S1 ®P ? T n (1) 87
inch x 63 UT to Richardson
® PER ? INT
6 Feet
30 Feet
inch x 70 Creek
foot long
CMPA
S2 ? P ® T Dewater UT to Richardson ® PER ? INT 6 Feet 80 Feet
Stream Creek
S3 ? P ? T ? PER ?'INT
S4 ? P ? T ? PER ? INT
S5 ? P ? T ? PER ?INT
S6 ? P ? T ? PER ? INT
30 Feet
39. Total stream and tributary impacts Permanent
80 Feet
Temporary
Page 5 of 12
PCN Form - Version 1.0 November 2008 Version
C. Proposed Impacts Inventory, continued
3h. Comments: The existing pipe at this crossing measures 40 feet in length and the proposed impacts for the replacement
pipe is 15 linear feet. Temporary impacts due to dewatering (if required - stream is dry) will not exceed 75 linear feet.

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 individual) list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of
impact number waterbody Type of impact Waterbody type Area of impact (acres)
- Permanent (if
(P) or applicable)
Temporary T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
M. Total open water impacts
4g. Comments:
Page 6 of 12
PCN Form - November 2008 Version
C. Proposed Impacts Inventory, continued
5. Pond or Lake Construction
If and or lake construction pro osed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or (acres)
number purpose of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments:
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):
51k. 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 miti ation, then ou MUST fill out Section D of this form.
6a.
? Neuse ?Tor-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact (square Zone 2 impact
Permanent (P) for impact Stream name mitigation feet) (square feet)
or Temporary required?
T
131 ?P?T ?Yes ?No
B2 ?P?T ?Yes ?No
B3 ?P?T ?Yes ?No
6h. Total buffer impacts
6i. Comments:
Page 7 of 12
PCN Form - November 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
NCDOT will only be installing the length of pipe necessary to construct a safe road shoulder and establish a stable
shoulder slope. The work area will be dewatered as needed throughout the construction process in an effort to minimize
sediment loss.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Impacts will be minimized by installing appropriate erosion control measures and keeping the site dewatered throughout
the construction process.
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 in-lieu fee program

? Permittee 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
4 Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. . Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 8 of 12
PCN Form - Version 1.0 November 2008 Version
D. Impact Justification and Mitigation, continued
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 Reason for impact Total impact
(square feet) Multiplier Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
Total buffer mitigation required:
6c. 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).
6d. Comments:
Page 9 of 12
PCN Form - November 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified ? Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? ? Yes ? No
2. Determination if the Project Requires a Stormwater Management Plan
2a. Does the project require a Non-404 Jurisdictional General Permit? ? Yes ® No
2b. Is the project subject to General Certification 3704 or 3705? ? Yes ® No
3. Determination of Stormwater Review Jurisdiction
3a. Is this project subject to any of the following state-implemented stormwater ? Coastal counties
? HOW
management programs (check all that apply)? ? ORW
If so, attach one copy of the approval letter from the DWQ and one copy of the ? Session Law 2006-246
approved stormwater management plan. ® Other: NCDOT NCS000250
3b. In which local government's jurisdiction is this project? Union County
3c. Is this local government certified to implement a state stormwater program? ? Yes ® No
If so, attach one copy of the approval letter from the local government and one copy
of the approved stormwater management plan (or one copy of the approved
Stormwater management plan stamped as approved).
4. Information Required for DWQ 401 Unit Stormwater Review
4a. What is the overall percent imperviousness according to the most current site plan?
4b. Does this project contain any areas that meet the criteria for "high density" per ? Yes ® No
General Certifications 3704 and 3705?
4c. If the site is over 24% impervious and/or contains high density areas, then provide a brief narrative description of the
stormwater management plan.
The proposed pipe replacement project will not increase the existing impervious area.
4d. Has a completed BMP Supplement Form with all required items been submitted ? Yes ? No
for each stormwater BMP?
Page 10 of 12
PCN Form - Version 1.0 November 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the ® Yes ? No
use of public (federal/state) land?
1 b. 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)?
1c. 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
? Yes
? No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 213 .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 quality?
3b. If you answered "yes" 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.
Page 11 of 12
PCN Form - Version 1.0 November 2008 Version
F. Supplementary Information, continued
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or ? Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ? No
impacts?
El Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Natural Heritage GIS data layer and a field review conducted by NCDOT biologists.
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?
South Atlantic Fishery Management Council
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?
National Register of Historic Places and NC State Historic Preservation Office
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: NCDOT engineers have determined that there will be "no rise" in
the base flood height elevation as a result of this pipe replacement project.
8c. What source(s) did you use to make the floodplain determination? NCDOT GIS data layer

Barry S. Moose sora.a I
07/21/10
Applicant/Agent's Printed Name Appheant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant Date
is provided.)
Page 12 of 12
PCN Form - November 2008 Version
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