HomeMy WebLinkAbout20151329 Ver 1_Application_20151218..x�a � i � ' K I�� � :
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PROJECT NUMBER • 11B 200311
STRUCTURE NUMBER: C300
ROAD NUMBER: SR 1172
COUNTY: ALLEGHANY
STREAM NAME: BLEDSOE CREEK
STREAM CLASSIFICATION: CLASS C•TR.
STREAM WIDTH: 14' WIDE
SHEET: 1 OF 1
DATE: 12/17/2015
EC DRAWN BY: D. A WpYNE # 244
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Th� NC Department of Transpartation is e�periencing bank ��asi�n behind the headwall
�f tl�e subj ect culvert �oca�ed in Sparta. �epairs need to be made be�ore �e �as� more ��
the shoulde�° or part of a travel lan�. We are prc�posing to redeposit soil Inta ihe eroded
hol� and plaie the face of the fill �vith �lass II stone. Total d�star�ce of ar�nor plating will
be appr�ximately 2� linear feet along �3ledsoe �reek {�lass: �; Trout). This vvill all�w
us to reestablish our shoulder and stop th� ong�ing erosian problem.
The proposed activity wlll require temporary dewatering. An irnper�iaus sandbag dike
will be cQnstructed to isolate the constructic�n area. �ny dirty water loca�ed inside of the
canstruction area will be pumped into a silt bag if necessary_ Precanstruction s�reambed
elevations will be restored once the v�ork is complete. Dewate�ing impacts wi11 total 4�
linear feei.
This prc�j ect was reviewed for the presence of t�reatened and endangered species. There
are bog �urtles in the general area but the proj ect is very lim�ted in s�ope and wlll have no
effec� on any federally listed endangered plant or animal species. No tree c�.tting is
needed �o make �he repa�rs. I�i�toric compliance wor� is unr�e�essary due to the scope of
.
the �epa�r.
T�e proj ect impacts are not signlf cant in nature and should improve �va�e� quality b�
eliminating the ongoing erosion Issue. Downstream water quality sta.�dards wi11 be
protected by util�zing apprc�priate BR�IPs during construction.
�'��th��g �c��par�es 5...�..._
State af North Caroiina j Department of Transportation ( Division Eieven
801 Statesville Road j PO Box 250 � North VVilkesbora, NC 28659-0250
336 66� 911 I T
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�ed.t�l ���.Llg�lte�'
I)ivis�c�n ��viro �nt�.I �fficer
ce e ��Iarla Ch�.mb�rs, NC��R�
1��n� Chapman, I��v�si�n c�f Wa�er Qualit� {2 �api�s}
i��Iike Pet�yj oh�, PE, D��ision �nglneer
David �Uayne, PE, Bridge 11�Iaintenance Engineer
�Ieath Slaugh�er, �ivision Environmenta� Officer
Zack Souther, Roadside Environmental Field �perations Techn�eian
��G� ��E' ��1��:
���pS �C�It}� 4� ��,
���� pr°€���e� r��.
��rrr� �/er�i�r� � .3 �e� 1 � Z�C��
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� $ �
�m .�. li���� I�f�����i�r�
� � �r�������g
� a. Type{�} �� �ppr�val s�ug�t �r�� �h� � i �c�i�n 'I � �ermi�
�r �: � e�t �r� 4�Q� P��r��f � � � �
�
1 b. �p�cif� �ti�nwide �r�i� { VU�} ��mb�r: 3 or �eneral �r�it {�F�} n�r�ber:
1 �. �� th� �r r�ur�b�r be�r� ��ri�i�d by �h� ��rp�� ❑ ��� � �
1 d. ��p�{�} �f �ppr�v�l s��agh� frQn1 th� DVV� ��heck al� ���� �pp1y}:
� A�O� a�er �alit� ��rtifica�i�� — e��lar ��r�-4�44 J�risd�ctie�r��l er��r�l ��rr�it
� 401 VVater �u�li�y �er�if c��ion — Expres� [� F�iparian Su�fer Au�horiza�i��
1�. 6s this r�oti�ca#ian solely �or �he record �or the rec�rd �nly far �UVQ 401 F�r �h� rec�rd or��y f�r C��ps �err�i�:
because writt�n approva! is nc�t required? Cer#ification:
� �es � �o ❑ �es � �o
1 f. Is payment int� a mitigation b�nk �r �r��lieu fee program proposed for mitigatio� ���s � No
of impacts? If so, attach the acceptance �e�ter from mi�igatior� bank or in-lieu
fee program.
� g. [s the pro�ect located in any of NC's twenty coas#al coun�ies. If yes, answer 1 h ❑ Yes � No
below.
1 h. Is the project I�cated �i�hin a NC DC� Area of Environmen�al Concern {AE�}? ❑ Yes � No
2. Project Information
2a. Name of project: Culver� #300
2b. County: Alleghany
2c. Nearest municipali#y / town: Sparta
2d. �ubdivision name:
2e. NCDOT only, T.I.P. or sta#e 11 B.200311
projec# no:
3. Owner Informatian
3a. Name{s} on Recarded Deed: NCDQT
3b. Deed� Book and Page No.
3c. Responsible Party (for LL� i f
applicable}:
3d. Street address: 801 Statesville Road
3e. City, state, zip: North Wilkes�oro, NC 28�59
3f, Tefephone noo: 336-9�3-92�2
3g. Fax na.: 33�-�67-4549
3h. Email address: hslaughter��ncdo#.�ov
Page 1 of 10
PCN Form — Version 1.3 December 10, 2008 Versio�
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4�. ��p�i���� i�: � �g�r�� � �����, �p���fy:
4b. �r��:
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, t���� �ddr���:
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4f. Telephor�e ��.:
�g. Fa� ��..
4h. �mai! add�e�s.
. � �/ �� � � f r #i {�f �� 1��
5�. �la�e:
5b. usiness narr�e
{if applicable}.
5c, �treet addre��:
5d. City, s�ate, zip:
5e. Telephone no.:
5f. Fax nc�.:
5g. Emai1 addr�ss:
Page 2 of 10
PCN Form — Version 1.3 December 10, 2008 Version
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� � � �fl 1
� , �� � � � �1�1����1 �1 �i�, �� � � � �� � � }:
�. i� ���r ir���� {i ��i I gr���}: L��t�ad�. 3�.5� 1 ��� i��dee - 81. � 24�74
�a�.t������} {-��.ag��at�}
��. ����erty Size: �.� ��reS
. �� �t r
2�. �lame af r�e�r��t b�dy �� ���e� {s�rea�, ri�er, e��.} �� �ied��e ��ee�c
pr�po��� prc�ject;
2b. Wa�e� C��ali�� �I��s�fic�ti�n a€ neare�� recei�i�g �rat�r: �; �"ro��
2c. �iver basi�. �ew
3. �r�je�t C�es�r�p#i�n
3�. �3escribe th� �xisiing c�nditi�r�s on the site ar�d �he general lar�d �se ir� th� vicinity of �he pr�j�c� �� the �i�e c�f �hi�
applicatian:
�aved road �rrith grassed shoulders in an urban set�ing ai�ng a�C route.
3b. List the t�tal estirnated acreage �f all existing �retlands ar� the pr�perty:
0 acre�
3c. Lis� the tofial estimated linear feet af all existing streams {ir�terme�tent and perenr�ial} on the prop�rty:
stream crossing
3d. �xp�ain �he p�rpose of ihe proposed project: �
�tab�iize sh��ld�r
3e. Describe the overall project in detail, including the type c�f equipment �o be used:
See attached cover letter.
4. Jurisdictional Determinatic�ns
4a. Have jurisdictior�al we#land or stream determina�i�ns by �he
Corps ar State been requested or obtained for this property i
praject (including all priar phases) in �he past? ❑��s � No � Unknown
Comments:
4b. If the Corps made the jurisdictional determinatian, what �ype
o# determination was made? � Preliminary ❑ Final
4c, if yes, who delineated the jurisdictional areas? Agency/Cons�ltant Company:
Name (ifi known}: flther:
4d. If yes, list #he dates of the �orps jurisdictional determinations or State d�terminations and attach documentation.
5. Project History
�a. Have permits or cer�ifications been requested or obtained for � Y�� � No ❑ tJnknown
this project {including all prior phases) in the past?
5b. !f yes, explain in de#ail according to "help file" ins�ructians.
G. Future Project Plans
�a. Is this a phased project? � Yes � No
�b. If yes, explain.
Page 3 of 10
PCN Farm — Version 1.3 December 10, 2048 Version
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1. �r�p�c�� t�r�r�ar�
� �. hi�� ����i�r�� er� �� p����d �e��� f�r y��r ���j��t {ch��� �I� �h�� �������
e�l��d� �r���� - �ri ��ar��� ��f���
p�r� ���r� �r�d ����r���i�r�
2. VVe��a�d Imp����
�f there are �e�iand ir�p�cts prapos�d gn ��e si#e, �her� �or�pl�t� t�is q�es�i�r� for �aci� uv�tla�d area imp�cted.
2�. 2b. 2c. 2d. 2�. 2�.
�tl�r�d im�ac� �y�� of j�ri�dic�ior�
n�rnber — T�p� �f ir�p�c� Type �� ����and F�re��ed ��orp� - 4�4, � 0 re� of im����
F��rmane�� �P} �r {i�f kr�av�r�� C� — non-444, oth�r} ���res}
Tern ora `T
i ���i
� Ye� [� �orps
� �o [� DW�
� �es � Corps
2 ❑ P i` D
❑ i�o ❑ Wt�
❑ Yes ❑ �orp�
3 � � � � DW
❑ Nc� ❑ Q
0 Yes ❑ Cc�rps
11�J4 ❑ P ❑ T DW
� No C] Q
❑ Yes Q corps
VV5 � P� i N DW
❑ � ❑ �
❑ Yes ❑ Gorps
1i�1� ❑ P❑ T N DW
❑ o ❑ �
2g, Total wetland impacts
2h. Comments:
3. Stream impacts
If there are perennial or intermit�en� stream impacts (including te�nporary impacts) proposed on �he site, then complete thi�
question for all stream sites impac�ed.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact S�ream name Perennial Type of jurisdiction Average Impact
number - (PER) or {Corps - 404, 10 stream iength
Permanent {P} or intermittent DWQ — non-4�4, width (linear
Temporary (T) {INT}? ather} (feet) feet)
Riprap & � PER � Corps
S�� P� T Dewaterin B��dsoe Creek ��T D� � 10 �Q
� � � Q
❑ PER ❑ Corps
S2 ❑ P❑ T I�IT DW
❑ ❑ �
� PER ❑ Corps
�� � � � T INT DW
� ❑ �
❑ PER ❑ Corps
S4 ❑ P❑ T 1 NT DW
❑ ❑ �
� PER ❑ Corps
S5 [� P 0 T INT � DW
❑ ❑ Q
❑ PER Q Corps
S6 0 P❑ T I NT aW
❑ ❑ �
3h..Total siream and tributary impacts �0
3i. Comments: 40 linear feet of the impacts are tempc�rary dewatering, 2� feet riprap
Page 4 af 1 Q
PCN Form — Version 1.3 December � Q, 2008 �lersion
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�� ���r� �r� pI �p���d ��p���� �� �����, p��d�, �����r���, ���lsJ�6�r� �, �7��� �, 6i :� ��I���i� ����, �r �y ��� r � �� ���r �
��e , . �I�er� ��d��id�a��y �i�� �I� �p�� ���r i�p�c�� b����.
4�, 4��, 4�a �� II .
p�r� ���r ar�� � a��rb�dy
��p��fi ��r�b�r — �i� pli� bl�� T� � � �� ���r � � �� r f � p �� { �r��}
�r���er�� { } �r
Tem �ra �
C)1 � P � �i
�2 �F'Q�
C�3 � P��'
�� (� P[��
f, T�i�1 �pe� �a���° i �a��s
4g. �ommenis.
a �nd ar l�ak� on��r�ctic�
�f ond or lake ��r�s�r�c�ic�r� �� �sed, �h�r� c�m let� �h� �har� b�Iow.
5ae �b. 5c. 5d. �e.
l�Je�iand Imp��ts {acr�s} �tream Impa�i� {f�et} �pland
i'ond 1D Prc�posed use or purpose {acres}
number of pond
Flooded Filled Excavated Flc�oded Filled Excavated Flooded
P1
PZ
5f. Total
�g. Commen��: NIA
5h. Is a dam high hazard permit required?
❑ Yes � Na If yes, permit ID no:
5i. Expected pond surface area {acres}:
5j. Size of pand wa�ershed (acres}:
5k. Method of construction:
f. Buffer Impacts {for DWQ}
If project wili 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 aut Section D�f this farrn.
Ga.
❑ Neuse ❑ Tar-Pamlico ❑ Other:
Project is in which protected basin? ❑ Catawba � Randleman
�b. �c. �d. 6e. Gf. 6g.
Buffer impact
number — Reason Buffer �one 1 impact Zone 2 impac#
Permanen� �P} or for Stream name r�i�igation (sq�are feet} (square feet}
Tem ora T im act re �ir�d?
❑ Yes
B1 ❑P❑T No
❑
0 Yes
B2 ❑P❑T No
�
C� Yes
B3 ❑ P 0 T No
❑
6h. Tatal buffer impacts
6i. Comments:
Page 5 of 1 �
PCN Form — Version 1.3 December 10, 2Q08 Version
� I � �� i� ti i�i �ti
s i � � i ��
� �. �pe�ifi�a�ly de����b� r�e��car�� �ak�r� �� ����d �� ���i���� �h� pr�p���d ir������ �� ����g�i�g p��j�c�.
ripr�p ���g�� i� the r����r�c�r� ��eded.
� b. �p�c�f����y de��rib� r�����re� ��ke� �� ����d �r ��r�i�iz� �h� �r�p�s�d ir������ �h���c�� ��r���������r� ���hr�iq���,
�i� �ppr�pr�at� ��1�� �il� b� �s�d durir�g cc�r�str�c�i��
� �a ���14/LY■ 9����s Y ����Lr[M��iB� ��� �dR i�M��� �� O i �.����� V� ��� ���0 7�R� �bS�M�� M� ��� ��Vl��
� d 1d
2�. ��e� �he pr�jec� requi�e �4�nper�sa��ry �itig��io� f�r � �'es � ��
im�ac�s t� a�ers of th� ..�r aiers �f ��� �ta�e?
2b. If yes, m�t�ga�i�on is r�quir�d by (check a11 tha� app1Y}: �VV� ��orp�
� itig�t�o� bank
2c. If yes, which �itiga� i�� �ption vvill be used f�r thi�
ro'ec�? ❑ Payrr���� �� i�-�i�� f�� pr�gra
� 1
` ❑ Perr�nitt�e Re�p�nsible li�itigatior�
. ar�p��t� �f �ir�g � Mit�g�tian �r�k
3�. Name of Mitigati�n Bank:
3b. �redits Purch�sed (attach re�eipt �r�d I�t��r} �ype Quantity
3c. Commen�s:
4. Complete if Making a Payment to In-lieu F'ee 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: 0 warrr� ❑ cool ❑cc�ld
4d. Buffer mitigation requested {DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal {tidal) wetland mitigation requested: acres
4h. Gomments:
5. Complete if Using a Permittee Responsible Mitigation P1an
�a. If using a permittee responsible mitigation p1an, prc�vide a descripti�n of the proposed mitigation plan.
Page b of 14
PCN Form — Version 1.3 December 14, 2008 Version
� r ��i �i t t � � � � r� � � � � r � r�
. il� ��� ������ �e���� �� r� � ���� i�h�r� pr�t����d �ip�ri�� b��e� ���� ��q�i�e� � �(�� �
b�ff�� ���� ������
a �f y��, ���� �d���i �� �q��r� fi��� �f � �t �� �� ���� �� ��� �i �r��� �f��r th � �� ��r�� ��'i ��i��, ����I��� �h
����r�t �f �iti ��i�� ��q�ir� .
�c. �d. �e,
��� e���r� ��� ir�pa�� �'�t�l i�p��� c�l�iplier eqcaired r�i�ig��i��
�squ�r� �fee�} {�q��re �ee�}
��r�e 1 3 {2 f�r ��ta�b��
���� 2 1.5
�f. 1'�t�l b�ffer i#ig�ti�n ��q�ireda
�g. #f buff�r mitiga�i�n is reguired, di�cuss �I�a� �ype of r�itiga�i�r� is pr�p�sed �e.g., p��ment t� priv�t� r�i�ig��i�� bank,
permit�ee respo�sible rip�ria� buffer r�st�ratior�, p�yment ir�#o an �pprQved in-lieu f�e fund}.
�h. ��rrnmer�ts:
Page 7 of 14
PCN Form — Version 1.3 December 1Q, 2Q08 Version
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� �. ��e� �h� pr�j��� i��l�d� �r �� i� ��j���r�� �� �r����t�d ri��r��r� ���f��� id�r��ifi�d ��� ��
�i�hir� ��� �f t�� �I� f�i �ri�r� �3c�f�er F�rc��ec�i�r� i������ � �
�
1 b. �f yes, �her� i� � diff�se f�o�nr �lan incl�ded� �f r��, �xp�air� v�rhy-
� ��� � o
�or�m�n��:
. t�r �t�r a � � �n� 1�
2�. VVh�# i� the �v���11 per��n� �rr�p�r�io�a�ness ��f th�� p����c�? °la
2b. C}ae� �his pr�je�� req�ire � ��c�rr��nr��er �ar�age�er�� �'���� [� Ye� � �i�
2c. If this projec� D�E� �(�T require a St�rmwa#er Managem�nt �lar�, explain �hy. Less than 1 acr�.
2d. If this project D��� r�quire a���rm�ater IVia�age�ent F'lar�, ther� pro�it�e a br�ef, n�rr�ti�e descripti�n of �he plar�:
� Certified Local Governmen�
2e. V1Jho will be respansibl� for �i�e r�view of the Stc�rmwater �anagemen� Plan� � DWQ Stormwater Program
❑ DWQ 401 Uni�
3. Certified Lc�cal Government Stormwater Review
3a. In which locai governmen#'s jurisdiction is this project?
❑ Phase II
3b. Which of the followin locali -im lemented stormwater mana ement ro rarns ����
� y� � p g 0 USMP
apply {check all that apply}:
❑ Water Supply Watershed
� Other:
3c. Has the approved Starmwater Management Plan with praof of approval been [� Yes � No
at�ached?
4. DWC� Stormwater Pro ram Review
0 Coas�al counties
❑ HQ1N
4a. Which of the following state-implemented stormwater management programs apply ���W
{check all that apply):
❑ Session Law 2Q06-246
� Other:
4b. Has #he approved Stormwater Management Plan wi#h prQof of approval been
at�ached? � Yes ❑ No
5. DW{,� 401 U n i� Sto rmwate r Review
5a. does the Stormwater Management Plan meet the appropriate requirements? ���S ���
5b. Have all of the 401 Unit submittal requirements been met? ❑ Yes ❑ No
Page 8 of 14
PCN Form — Version 1.3 December 10, 2008 Version
. � r �
� � �����r� ��t�� t���rr������i�� { �q��r� �r�t�
� �. ��� �i�� � j��� i���l� � �� ��d���r� �� ����i� �f� � �1�����I������ f�� � �r t��
�
�s� �� p�bli� {fe er��l�tate} land�
��. If yo� ar�s�rered "y��" t� �he �b�ve, does ��e prt�je�� req��r� prep�ra�i�r� �f �n
environmental doc�men� pursuar�t to �he req�irement� o� �he i�a�ic�r�al �r S��te � Y�s ��
��or�h ��r�lir�a} �nvir�r�m�r���l �'olicy Ac# {N�PA1�E�'A}�
1�. If you �r�swered "yes" �c� ��e ab�ve, has t�� doc�a��r�� r�vie�rr ���� fir�a�i�ed by ��e
�tate ��e��i�g I�o�s�� {�f s�, �tt�ch a �c�py of �he I��F�� �r ��F�A �r��l appro�al
I����r,� � ��� � 1��
�ornm�n�s:
. �o1�ti�ns � equir�men�}
2�. I� th� �i�e ir� vialatior� of �V1/C� 1l�e�land Rules {15A ���►� 2H .450Q}, �sc�lated
Wetland Rules {15A i�CAC 2N .1300}, �Wf� Surfac� VVa#er �r i�ie�land Stanc��rds, 0�e� � No
ar Riparian Eiuffer Rules {1 �A N�AG 2B .�ZOOj?
2b. �s this an afte�-th�-fact permit �pplica�ion? ❑ Y�s � I�o
2c. If you answered "yes" t� one or bo#h of the above ques�ions, provide an expla�atian of the violationts):
3o Cumulat�ve Impacts ��W{� Re�uiremen#�
3a. 1nlill this project {based on past and reasonably aniicipa�ed fu�ure impacts) result in ❑ Yes � Na
add�t�onal development, which could impact nearby d�wnstream water quality?
3b. If you answered "yes" ta the above, submit a qua�itative or quantita�ive cumulative impact analysis ir� accordance with the
most recen# DWQ policy. If yau answered "n�," prc�vide � shor� narra�ive description.
4. Sewage Disposal (DWQ Requirement}
4a. Clearly detail the ul�imate treatment methods and disposition �non-discharge ar discharge) af wastewater generated from
the proposed project, c�r available capaGity of th� subject facility.
NiA
Page � af 10
PCN Form —�lersion 1.3 December 10, 2008 Version
a � i � �i�� i i r �
��. V���� ���� pr�j��� ����� �r� �� ���r �� �r�� �'��� ��d�����y p�������d �p����� �� � ��� � ��
h�b�#���
5�. ���e y�� �h��k�� �i�� �h� l���V�� �����r���g ��d��g���� �p����� ��� ��� �I�
irnpac�s'?
� �
❑ �aleigF�
5�. I� ��s, ir�d ic��e �he �F �ie�d fific� y�� ha�� ��r�����ed.
Q ��he�ill�
5d. h�t d�t� ��t�r��� did ��u ��� �� determ��� h�ther y��� �i�� ����d ��p��� Er�d�r�g�r�d �p��ie� �r ��igna#�d �r�ti�a�
Habii�t?
r
�1S and vi�ual observa�ior�
� ���r����l ��h �bit�� � �rps �qu�r� ��#�
6�,1li�ill this proj�c� �ccur ir� or near �� area designa�ed as es�enti�l �sh habi�a�? ❑ Ye� � h10
�b. 1/Vnat data sourc�s did y�� us� to determine v�rhe�her your site would impact Essential Fish Habi�at?
UVRC will comm���
7e Flistc�ric o� f�reh�stori� �ultural �esources {�orps F�eq�irer�ent)
7�. �il�ill �h�s pr�je�.� oc��r i� �� ���r �� area �h�� �h� �tat�, ����r�� �r t��b��
governments have designated as having histori� or cultural preservation ���� ���
status {e.g., Natiflnal Histori� Trust designation or properties signi�cant in
�lorth Carolina history and archaeolagy}?
7b. What data sources did you use to determine whe�her your site uvould impact historic or archeological resources?
Project sco�e.
8. Flood Zane Designation {Corps Requirement}
8a. Will this project occur in a FEMA-designa�ed 100-year floodplain? ❑ Yes �j No
8b. If yes, explain how project meets FEMA requirements:
8c. What source{s) did you use to make the floodplain determination? ncfloodmaps
J, �-Ieath Slaughter � 12I� 8115
�
A licant/A ent's Printed Name Rpplican�IAgen�' ignature Date
p� g {Agent's s nature is valid only if an a arizatian letter fram the applicant
is provided.)
Page 10 af �Q
PCN Form — Version 1.3 December 10, 2008 Versian