20221112 Ver 1_19-08-0004_EffectsSigned_20220818

Project Tracking No. (Internal Use
19-08-0004
VM.*--
HISTORIC ARCHITECTURE AND LANDSCAPES 5
ASSESSMENT OF EFFECTS FORM
This form only pertains to Historic Architecture and Landscapes for this project. It
is not valid for Archaeological Resources. You must consult separately with the
Archaeology Group.
PROJECT INFORMATION
Project No:
County:
Pasquotank
WBSNo.:
17BP.1.R.88
Document
Type:
Federal CE
Fed. Aid No:
Funding:
® State ❑ Federal
Federal
Permits :
® Yes ❑ No
Permit
Typ e s :
USACE
Project Description:
Replace Bridge No. 5 on SR 1103 (Esclip Rd) over Chapel Creek.
SUMMARY OF HISTORIC ARCHITECTURE AND LANDSCAPES REVIEW
Description of review activities, results, and conclusions:
This project is state -funded with federal permits or funding. The National Register eligible Union
United Methodist Church (PK0808) is within the project area. An Effects Meeting was held on
January 27, 2022. The findings are as follows.
ASSESSMENT OF EFFECTS
Property Name:
Union United Methodist
Status:
DE
Church
Survey Site No.:
PK0808
PIN. -
Effects
❑ No Effect ® No Adverse Effect ❑ Adverse Effect
Explanation of Effects Determination:
There will be no adverse effect to the resource with the condition of a two -bar metal rail for the
new bridge.
List of Environmental Commitments:
The grave sites will be marked by orange safety fencing; the staging area will remain within
existing ROW and will be noted on final plans.
Historic Architecture and Landscapes EFFECTS ASSESSMENT form for Minor Transportation Projects as Qualified in the 2007 Programmatic Agreement.
Page 1 of 2

SUPPORT DOCUMENTATION
❑Map(s) ❑Previous Survey Info. ❑Photos ❑Correspondence ®Design Plans
FINDING BY NCDOT AND STATE HISTORIC PRESERVATION OFFICE
Historic Architecture and Landscapes —ASSESSMENT OF EFFECTS
DocuSigned by:
08/08/2022
NCDOT Architectural Historian Date
—DocuSigned by:
kmtt, 2"t, 08/08/2022
State Historic Preservation Office Representative Date
gned by:
K bayu)-s
Federal Agency Representative
08/17/2022
Date
Historic Architecture and Landscapes /iFFFCTSASSFSSMF_NT form for Minor Transportation Projects as Qualified in the 2007 Programmatic Agreement
Page 2 of 2

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BRIDGE AND ROADWAY RELATIONSHIP SKETCH
SR 1103 BRIDGE NO.5 OVER CHAPEL CREEK
(NOT TO SCALE)
ALL CONSTRUCTION STAGING WILL
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DEWATERING AND ROADWAY SHOULDERS
STREAM & WETLAND IMPACTS
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WETLAND
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CLEARING NOTES:
DETAIL 4- SPECIAL C CH DENOTES IMPACTS IN SEE SHEET 5 FOR 4-, PROFILE
1 1.1 SURFACE WATER AL ' RIVES- HAVE 10' RADIUS UNLESS OTHERWISE NOTED
` ® DENOTES TEMPORARY /** S SHEET 2C�4 FOR OEOTECH DETAILS
IMPACTS IN SURFACE WATER
ARn.D= 0 PAVED SHOUL�_ R i
RO _L- STA. 14+ 70 15+00 LT -
ROM A- STA. IS O 16+50 LT
RO 1� SfA. 16 5 16+5 RT ` j
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