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� � Corps actian I D na.
� �.
� � �` -� DWQ rc��ect no.
� � � � "��� ?������������; P 1
������ Fa�rm Version 1.3 Dec 14 2�Q8
�'�r�-Cons�ructi+�n Noti�icati�n �'CGI� �'or
A. A licant Information
1. Prbcessing
1 a. Type(s) of approval sought from the
��� S: � Section 404 Permit [� Sectic�n 1Q Permit
p
1 b. �pecify Nationwide Pe�rmit {NWP} number: 14 or General Permit {GP} number:
1 c. Has the NWP or GP number been verified by the Carps? ❑ Yes � No
1 d. Type{s} of approval sought frorn the DWQ (check all that apply):
� 441 W�ter Quality Certification — Regular ❑ N�n-4�U4 Jurisdiction�l General Permit
❑ 40'1 Water Quality Certification — Express 0 Riparian Buffer Authc�riZation
1 e. Is this notification solely for the record For the record c�niy for DWQ 401 For th� rec�rd only for Corps Permit:
because written approvai is nofi required? Cerkification:
❑ Yes � Na ❑ Yes � No
1 f. Is payment into � mitigation bank or in-lieu fee program proposed for mitigation � Yes � No
o f impac ts? 1 f sa, a t tac h t he �ccep tance le t ter fram mi tiga tio� b�n k or in- lieu
fee prc�gram.
1 g. Is the project lacated in any of NC's twenty coastal counties. If yes, answer 1 h ❑ Yes � No
below.
1 h. Is the project located within a NC DCM Are� of Environmental Concern (AEC)? � Yes � Na
2. Project Information
2a. Name nf project: SR 2610, Greenberry Lan�
2b. County: Wilkes
2c. Nearest municipality / town: Nc�rth Wilkesbaro
2d. Subdivision n�me.
2e. NCDC7T only, T. I. P. or state 11 C.097167
project na:
3. CJwner lnfiorm�tion
3a. Name{s) on Recarded Deed: NCDCJT .
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicabl�):
3d. Street address: 801 Statesville Road
3e. City, state, zip: Narth Wilkesboro, NC 28�59
3f. Telephane no.: 336-903-9202
3g. Fax no.: 33�-�67-4549
3h. Email address: hslaughter��ncdafi.gov
Page 1 of 10
P�N Form -- Version '1.3 December 1 O, 2U�8 Version
4. Applicant Information (sf different from c�wner)
4a. Appiicant is; ❑ Agent ❑ Ofiher, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address.
5. Agenfi/Consultant Information (if applicable)
5a. Name:
5b. Business name
(if applic�ble}:
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. F�x no.:
5g. Email address:
Page 2 of 10
PCN Form -- Version 1.3 Decernber 14, 20a8 Ver�ic�n
B. Prc�ject tnformation and Prior Projec� History
1, Property Identificatic�n
'I a. Property identification no. (t�x PIN or parcel ID):
1 b. Site coc�rdin�tes (in decimal degrees): L�titude: 36.14�44 Longitude. - 81.�8819
(DD. DD�DDD) (-Da. DDDDDD�
1 c. Property size: 1.4 acres
Z. S u rfac�e Wate rs
2a. Name o�F near�st body of water (stream, river, etc.) to UT t� Fishing Greek
proposed pra�ect:
2b. W�ter Qu�lity Classification of nearest receiving water: C
2c. River b�sin: Y�dkin
3. Project Descript�on
3a. Describe the existing conditions on the site and the general I�nd use in the vicinity of the project at the time of this
application: � �
Unpaved road in a rura! area.
3b. List the total estimated acreage of all existing wetlands c�n th� properky:
4 acres
3c. List the total estimated linear feet of ail existing streams (intermittent and per�nnial) on the property:
45 linear feet
3d. Explain the purpose of the proposed project:
Upgrade roadway as part of road addition.
3e. Describe the overall project in detail, including the type Qf eq�uipment to be used:
See attachec� cover letter.
4. Jurisdictional Determinatians
4a. Have jurisdiction�l wetland or stream determinations by the
Carps or State been requested or obtained for this property I
project (including all prior phases} in the past? ❑�'es (�j No [� Unknawn
Camments:
4b. If the Corps made the jurisdictional determination, what type
of determinatian was made? � Preliminary [,� Final
4c. If yes, who delineated the jurisdictional areas? Agency/Cansulfiant Cornp�ny:
Name {if knovvn): C�ther:
4d. If yes, list the dates af the Corps jurisdictional determinations or State determin�tic�ns and attach documentation.
5. Project His�ory
5a. Have permits or certifications been requested or obtained for � Yes � No ❑ Unknown
th�s pro�ect (rncluding all prior phas�s} in the past?
5b. if yes, explain in detail according to "help fiife" instructions.
6. Future Prc��ect Plans
6a. 1s this a phased project? C] Yes � No
6b. If yes, explain.
Page 3 c�f 10
P�N Form — Versian 1.3 December 1�, 20�8 Ver�ion
C. Proposed Imp�cts Inventory
1. Imp�cts �ummary
1a. Which sections were compieted below for ynur proje�t (check all that apply): �
❑ Wetlands � Streams - tributaries ❑ BufFers
�] CJpen W�ters ❑ Pand Construction
2. Wetland impacts
If there are wetland imp�cts propo�ed on the site, then compiete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type c�f jurisdiction
number — Type of impact Type of wetland Forested (Corps - 4�04, 1 a Area of impact
Permanent (P) or {if known) DWQ — non-4�4, other) (acres)
Tem ora T
❑ Y�s ❑ Corps
W1 ❑ P❑ T N� DWQ
❑ ❑
[� Yes ❑ Corps
W2 ❑ P❑ T N� DWQ
❑ 0
❑ Y+�s [� Corps
W3 ❑ P❑ T No DWQ
❑ ❑
❑ Y�s ❑ Carps
W4 ❑ P❑ T N o DWQ
0 ❑
❑ Yes � Corps
W5 ❑ P❑ T N� DWQ
❑ ❑
[� Yes [� Corps
W6 ❑ P❑ T Nq DWQ
❑ 0
2g. Total wetland impacis
2h. Camments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including tempor�ry impacts) proposed an �he site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. �g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average imp�ct
number - (P�R} or (Corps - 4�4, 10 stre�m len9th
Permanent (P) or intermittent DWQ -- non-404, width (linear
Temporary (T) (Ii�T)? other) �feet) feet)
Pipe, Riprap & UT to Fishing � PER � Corps
51 � P�) T Dewaterin Creek INT DWQ 1 ��
9 ❑ �
❑ PER [] Corps
S2 ❑ P❑ T lNT DWC�
❑ ❑
❑ PER ❑ Carps
S3 ❑ P❑ T I NT DWt�
❑ ❑
�j PER [� C�rps
S4 ❑ P❑ T INT DWQ
0 �
❑ P�R [.� �orps
S5 ❑ P❑ T INT CJWQ
❑ ❑
❑ P�R ❑ Corps
S6 ❑ P❑ T I NT aWQ
� ❑
3h. Total stream and tributary impacts 6�
3i. Comments: 16 pipe, 1 � riprap, 4� dewater
Page 4 of 10
P�N Form -- Version 1.3 December 1�, 2048 Ver�ion
4. C�pen Water Impacts
If there are praposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic C�cean, or any other open vti+�ater of
the 1J.5. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
t�pen water Name of waterbody
impact number — (if appiicable) Type of impa�t Waterbody type Are� of imp�ct {�cres)
Permanent {P) or
Tem ora T
01 ❑ P❑T
02 [�]P❑T
03 QP❑T
CJ4 ❑P❑T
4f, Total apen water impacts
4g. Comments:
5. Pond or �ak� Constructian
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impact� (acr�s} Stream imp�cts {feet) Upi�nd
Pond lD Propos�d use ar purpose (acres)
number a� p�n�
Flooded Fiiled Excavated Floc�ded Filled Exc�v�ted Flooded
P1
P2
5f. Total
5g. Comments: N/A
5h. ls a dam high hazard permit required?
❑ Yes (�j �lo If yes, permit I� no:
5i. Expected pand surface area (acres):
5j. Si�e of pand watershed (acres}:
5k. Method of construction:
f. Buffer Impacts (for DWQ)
If project will impact a protected riparian buff�r, then complete the ch�rt below. If yes, then individually list afl bufiFer impacts
below. if �n impact� r�quire miti ation, then ou MUS�' fili c�ut �ection D of this form.
6a.
❑ Neuse [� Tar-P�mlico ❑ tJther:
Project is in which protected basin? ❑ Catawba 0 R�ndieman
6b. 6c. 6d. 6e. 6f. 6g.
BufiFer impact
number -- Reas�n Buff�r Zone 1 impact Z�ne 2 imp�ct
Permanent (P} or for Stream name mitigation (squ�re feetj (�quare feet}
Tem ora T im act re uired?
❑ Yes
g1 ❑ P ❑ T ❑ I�o
❑ Yes
B2 C]P❑T �No
❑ Yes
�� �p�T ❑No
6h. Total bu�fer �mpacts
6i. Comments:
Page 5 c�f 10
P�N �'orm — Version 1.3 Dec�mber 1�, 2U08 Version
C�. lmpact Justification and Mitigation
'1. Avoidance and �Vlinimization
1 a. Specificaily describe measures taken to avoid or minimize fih� proposed impacts in desi�ning project.
The pipe length is the minimum needed to improve roadway.
1 b. Specificaily describe measures taken ta avoid or minimize the propo�ed imp�cts through constructic�n techniques.
Ali �ppropriate BMPs will be used during construction
2. Campensator� Mitigatian for lmpacts to '�IVaters of the U.�. or Waters of �th� Siate
2a. Dc�es the project require �ompensatory Mitigation for ❑ Y�s � No
impacts to Waters of the U.S. or Waters af the State?
2b. If yes, mitigatiQn is required by (check all that apply): [] C�WQ ❑ Corps
❑ 1�iifiigation b�nk
2c. ff yes, which mitigation opfiic�n wiil be used for this
�.�.��t? [� �ayment fic� in-lieu fee program
p �
[] (�ermittee Responsible Mitigation
3. Gomplete if Using a Mifiigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter} iype Quantifiy
3c. Comments:
4. Complete if Making a Payment to In-Iieu Fee Program
4a. Approval letter from in-lieu fee program is attached. [� Y�s
4b. �tream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: [� w�rm ❑ coc�l ❑c�1d
4d. Buffer mitigation requested (DWQ only}: squ�re feet
4e. R.iparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigatian requested: acres
4g. Goastal (tidal) wetland mitig�tion requested: acres
4h. Comments:
5. Complete if Usir�g a Permittee R�sponsible Mitigation P1an
5a. If using a permittee responsible mitigation plan, provide a description of the propased mitigation plan.
Page�ofi1Q
P�N Form -- V�rsion 1.3 D�cember 1�, 2408 Versian
6. Buffer Mitigation �State Regulated Ftiparian �uffer Rules) — r�quired by C�WQ
6a. Will the project result in an impact within a protected riparian buff�r that requires ❑ 1�es � Na
bufFer mitigation?
�b. If yes, then identify the square feet of impact to each zone of the riparian buffer th�t requires mitig�tion. Calculate the
�mount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multipiier Required mitigation
(square feet} (square feet)
Zone 1 3 (2 for �atawba)
Zone 2 �.5
6f. Total buffer mitig�iian requir�ed:
6g. If buffer mitigation is required, discuss what type of mitigation is propc�sed (e.g., payment to private mitigation bank,
permittee responsible rip�rian buffer restoration, p�yment into �n �pproved in-lieu fee fund}.
�h. Comments:
P�ge 7 of 10
F�CN Form --Versian 1,3 December 1�, 2�08 V�rsion
E. Stormwater Management and Dififuse Fiow Plan (required by �WQ)
1. Diffuse Flow �'lan
1 a. Does the project include or is it adjacenfi to protected riparian buffers identified ���s � Na
with�n one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a�diffuse flow pian included? If no, explain why.
C� Y�s ❑ N c�
Comments:
Z. Stormwater Mana ement Plan
2a. Wh�� is the over�ll percent imperviousness of this project? %
2b. Does this project require a Stormwater Management Plan? ��es ❑ No
2c. If fihis project DOES NC?T require � Stormwater Management Plan, explain wh�:
2d. If this project DCJES require a Stormwater Management P1an, th�n provide a brief, narrative description of the plan:
Falls under DC�T NPDES Permit
❑ Certified L.oc�l Governm�nt
2e. Who will be r�sponsibie for the review of the Stormwater Management Plan� ❑ CJWC� Stormwater Progr�m
❑ LJWQ 4�1 Unit
3. �ertified Local Government Stormwater Review
3a. In which locai government's jurisdiction is this project?
❑ Phase II
3b. Which of the followin locali -im lemented stormwater mana err�ent ro rams � N��
9 Y p � p 9 ❑ USMP
apply (check all that apply):
❑ Water Supply W�tershed
❑ Other:
3c. Has the �pproved Stormwater Management Plan with praof of �pproval been [�j Yes ❑ No
attached?
4. C�V1/Q Stormwater Pro ram Review
(� �o�stal cc�unties
0 H �2�
4a. Which of the follawing state-impiemented stnrmwater managem�nt programs apply � p��
(check all th�t appiY):
❑ �essic�n Law 2�cJ�-�46
❑ Other:
4b. Has the approved Stormwater Management Plan with pro�f of appraval been
at�ached? ❑ Yes ❑ No
5. DWQ A��1 Unit Starmwater Review
5a. Daes the Stormwater Managerr�ent Plan meet the �pprapriate requirements'? � y�� ��Q
5b. Have all of the 401 Unit submittal requirements been met? ���� ❑��
Pa�� S of �o
P�N Form — Version 1.3 Qecember 10, 2008 Version
F. Supplementary information
1. Environmental Documentatifln (DWQ Requirement)
1 a, Daes the project involve an expenditure of pubiic (federal/state/lo�al) funds or the ��.�5 ���
use of pubi�c (federal/state) land?
1 b. if you answered "yes" to the above, does fihe project require prep�ration of an
environmen#al document pursuant ta the requirements of the National or State (� Yes � No
(North Carolina) Enviranmentai Policy Act (NEPA/�EPA)?
'I c. If you answered "yes" to the abave, has the document review be�n finalized by the
State Clearing House? (if so, attach a copy of the NEPA or :�EP� �nal approvai
letter.) ❑ Yes ❑ N�
Comments:
2. Violations (DWQ Requirement}
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .�5a0), lsolated
Wetland Rules {15A NCAC 2H .1300), DWQ �urface Water �r Wetl�nd Standards, ❑ Yes � No
ar Riparian Buffer Rules {15A NCAC 2B .q200)?
2b. Is this an after-the-fact permit application� ❑ Yes � Nc�
2c. If you answered "yes" to one or both of the above questians, provide an explanation of the violati�n{s):
3. �umulative impacts ��WQ Requirement)
3a. Wiil this project (based on past and reasonably anticipated future impact�} resuit in � yes � No
additional developrnent, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or q�antitative .cumulative impact analysis in accordance with the
most recent D1NQ policy. If you answered "no," provide � short n�rrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly det�il the ultimate treatment methods and disposition (nor�-discharge ar disch�rge} of wastew�ter gener�ted from
the proposed project, or available cap�city of the s�bject fa�i(ity.
N/A
Page9�f1Q
PCN Form — Version 1.3 December 10, 2048 Version
5. Endangered Species and Designated Griticai Habitat (Ct�rps Requ�rement)
5a. Wili this project occur in or near an area with federaily protected �pecies or � Y�� ��Q
habitat?
5b. Have you checked with the USFWS concerning Endangered Sp�cies Act C] Yes � No
i m p�cts'?
❑ R�leigh
5c. !f yes, indicate the U�FW� Field Office you have contacted.
[� Asheville
5d. What data saurces did you use to determine whether your site would impact Endangered Species or Designated Critic�l
H�bitat?
GiS �nd visual observation
�. Essential Fish Habitat {Corps Requirement)
6a. Vi/iil this project accur in or near an area designated as essential fish habitat? ❑ Yes � Nc�
6b. What data sources did you use to determine whether your site wouid impact Essenti�l Fish Habitat?
WRC will comment
7. Historic or Prehistaric Cultural Resources (�arps Requirement)
7a. Will this project occur in or near an area that the state, federai or tribal
governments have d�signated as having historic or cultural preservation .�,,es � Nc�
Tr st desi nation or ro erties si nificant in �
status {e.g., Natic�nal Histor�c u g p p g
North Carolina history and archaeoiogy)?
7b. What data sources did you use to determine whether your site would impact historic or archeological res�urces?
Project submitted to HEU
8. Floc�d Zone Designation tCorps Requirement}
8a. Will this project occur in a FEMA-designated 100-year flaodplain? (� Yes � No
8b. lf yes, explain how project meets FEMA requirements:
8c. What saurce(s) did you use to make the floodplain determinatior�? ncflaadmaps
J. I�eath Slau hter '������ �
�
�
���
A licant/A ent's Printed N�me �.pplic�nt/Agent's Sig ure D���
pp � (Agent's s nature is valid only if an authariz ' n letter fram the applicant
is provided.}
Page 1 � of 10
PCN Form — Version 1.3 December 10, 20�8 Ver�ion
1�t,� � �,n� •...,.
'd�, .
�� � ,,,
STATE OF NORTH CAROLINA
DEPART2VIENT OF 'TR:ANSPORTATICJN
. PA'I'Ri�K L: IVIGCRORY - _ _ __ __ _ __ . __ANTHONY J. TATA __
GOVERNOR SECRETARY
March 18, 2014
MEMOR.ANDLTM TO: Heath Slaughter
Division Environmental Officer
FROM: Christopher C Absher, P
Assistant District Engineer
SUBJECT: Permit Application Information far SR 2610 (Greenberry
�ane) in Wilkes County
Attached for your further handling is the requested information for obtaining the
necessary permits for the improvement and addition of SR 2610 (Greenberry Lane) in
Wilkes County. I have included the roadway construction plans, erosion control plan, a
county map, and a Topographic map indicating the location of the project.
The above project will consist of grading and drainage of SR 2610. The improvements
wil! begin at Station 00+00 and will end at Station 13+91. The total length of the project
is 0.26 miles.
As noted on the Minimum Criteria Determination Checklist, there is one wet pipe on the
project.
The average existing width of SR 1305 is 13 feet and the proposed width is 18 feet with
a total right-of-way of 45 feet. There are no historic buildings or other significant sites
within the proposed right-of-way of this project.
8hould you require additional information, please call.
CCAJcca
Attachments
cc: M. A. Pettyjohn, P.E.
Brian HambyP.E.
P.O. Box 250, North Wilkesboro, NC 28659
Phone: (336) 903-9146 F�: (336) 903-9219
MINIMUM CRITERIA DETERNIINATION CHECKLIST
The following questions provide direction in determining when the Department is
required to prepare environmental documents for state-fiinded construction and
maintenance activities. Answer questians for Parts A through C by checking either
. _ `=l�es" or "No�'� Complete P�xt I3 of t1i� cl�ecl�I��t �l�en Mi�u�iurt� e�teri�R�t� ___ _ ___.
categories #8, #12(i) or #15 are used.
TIP Project No.•
State Project No.: 11C.097167
Project Location: SR 2610 Greenberrv Lane, Wilkes County, NC
Project Description: Grade and Drain
Anticipated Permit or Consultation Requirements:
Special Project Informatian: There is one stream crossings within the project
limits and na si 'iYi� ficant structures tliat will be impacted by this proje�t. No trout buffer
variance will be needed on this pra�ect
03/18/14 1 of4
PART A: MINiMUM CRITERIA
Is the proposed project listed as a type and class of activity allowed under
the Minimum Criteria Rule in which environmental documenta,tion is not
required? �
If the answer to number 1 is "no", then the project does not qualify as a
minimum criteria project. A state environmental assessment is required.
If yes, under which category?
8
If either category #$, # 12{i) or # 15 is used, complete Part D af this checklist.
PART B: MINIMUM CRITERIA EXCEPTIONS
�te»�s 2,,� 4 tr� be �r�»:p�eted hy the E�igr�eer� ;:
2. Could the proposed activity cause significant changes in land use
concentrations that would be expected to create adverse air quality
impacts?
3. Wiil the proposed activity have secondary impacts or cumulative impacts
that may result in a significant adverse impact to human health or the
environment?
4. Is the proposed activity of such an unusual nature or does the propased
actiivity have such widespr�ad impli�ations, that an uncommon concern
for its environmental effects has been expressed to the Department?
YES
NO
❑ �
� �
���s:l
5. Does the proposed activity have a significant adverse effect on wetlands; � �
surface waters such as rivers, streams, and estuaries; parklands; prime or
unique agricultural lands; or areas of recognized scenic, recreational,
archaeological, or historical value?
6. Will the proposed activity endanger the e�cistence of a species on the � �
Deparhnent of Interior's threatened and endangered species list?
7, Could the proposed activity cause significant changes in land use
concentrations that would be expected to create adverse water quality or
ground water impacts?
03/18/14 2 of 4
❑ ❑
YES NO
8. Is the proposed activity expected t4 have a significant adverse effect on � �
long-term recreational benefits or shellfish, finfish, wildlife, or their
natural habitats
If any questions 2 thraugh $ are answered "yes", the proposed project may not qualify as a
Minimum Criteria project. A state environmental assessment (EA) may be required. For
assistance, contact:
Manager, Project Development and Environmental Analysis Branch
P. O. Box 25201
Raleigh, NC 27611
{919) �33 —3141
Fax: {919) 733-9794
PART C: COMPLIANCE WITH STATE AND FEDERAL REGULATIONS
9. Is a federally pratected threatened or endangered species, or its
habitat, likely to be impacted by the proposed action?
10. Does the action require the placement of temporary or permanent
fill in waters of the United States?
11. Does the project require the piacement of a significant amount of
fill in high qua.lity or relatively rare wetland ecosystems, such as
mountain bogs or pine sava�nahs?
12. Is the proposed action located in an Area of Environmental
Concern, as defined in the coasta.l Area Management Act?
��%�ns 13: i�` tQ I�e �omp��ed liy t�e ��g�c�eer :
13. T3aes the �roject require str�arn reloc�tion or channel changes?
Cultural Resources
13. Will the project have an "effect" on a property or site listed on the
Natianal Register of Historic Places?
14. Will the propased action require acquisition of additional right of
way from publicly aumed parkiand or recreational areas?
YES NO
❑ ❑
❑ �
❑ ❑
❑ �
❑ �
❑ �
❑ �
Questions in Part "C" are designed to assist the Engineer and the Division Environmental
O�cer in determining whether a pernut or consultation with a state or federal resource
agency may be required. If any questions in Part "C" are answered "yes", follow the
appropriate permitting procedures prior to beginning project construction.
03118t14 3 of 4
PART D: t To be completed when either cate�orv #$, #12(i) or #15 af the rules are
used.
_ "���,��`��� f� ��"����������'�i����r�r��`t�tif�,��; � ���x _ __ _
15. Project length:
16. Right of Way width:
17. Praject completion date:
18. Tota.l acres af newlv disturbed ground
surface:
19. Total acres af wetland impacts:
20. Totallinear feet of stream impacts:
21. Project purpose:
4.26 MILES
4S FEET
JANUARY l, 2015
1.5 ACRES
IMPROVEMENT
If Part D of the checklist is completed, send a copy of the entire checklist document to:
Don G. Lee
State Roadside Environmental Engineer
Mail Service Center 1557
Raleigh, NC 27699-1557
(919) 733-2920
Fax (919}733-9810
Emaii: dlee@dot.state.nc.us
Reviewed by: Date: �'�1 G� J
Lead gine�r
Date:
Division Environmental Officer
cc: Don Lee
03/18/14 4 of 4
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