20091133 Ver 1_Application_20091026

SR 1511, Watermelon Road
Page 2
October 20, 2009
project area. Bog turtles are usually found in bogs, marshes, and wet pastures. There is no
suitable habitat located within the project area. The proposed project will have a finding of "No
Effect" on the dwarf-flowered heartleaf (Hexastylis naniora) species or bog turtle (Clemmys
muhlenbergii).
I have enclosed a pre-construction notification for a NW#3, sketches of planned activities and
location maps relative to the project.
Project information for the 401 Automated Payment Procedure is as follows:
• Work order number: 150465-55120005-12B.204911-3300
• TIP#: NA
• Project Category: $240.00 Fee
If you have any questions or concerns please feel free to contact me at [phone]. Thank you for
your time and consideration on this matter.
Respectfully yours,
M.L. Holder, P.E.
Division Engineer
Twelfth Division
BY:
Trish Simon
Division 12 Environmental Supervisor
Enclosures
Cc: Polly Lespinasse, Division of Water Quality, Mooresville Regional Office
02OE W A rF'q
r
O r
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PCN Form
A. Applicant Information
1. Processing
la. Type(s) of approval sought from the

Corps:
® Section 404 Permit ? Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ? Yes N No
1d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
le. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
? Yes ® No For the record only for Corps Permit:

® Yes ? No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes N No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below. ? Yes ® No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: SR 1511 (Watermelon Road)
2b. County: Iredell
2c. Nearest municipality / town: Statesville
2d. Subdivision name: NA
2e. NCDOT only, T.I.P. or state
project no: 126 204911
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT Right of Way
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 11
PCN Form -Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ? Other, specify:
4b. Name: Mike Holder
4c. Business name
(if applicable): N.C. Department of Transportation, Division 12
4d. Street address: 1710 East Marion Street
4e. City, state, zip: Shelby, NC 28151
4f. Telephone no.: 704-480-9020
4g. Fax no.: 704-480-5401
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name: Trish Simon
5b. Business name
(if applicable): N.C. Department of Transportation, Division 12
5c. Street address: 1710 East Marion Street
5d. City, state, zip: Shelby, NC 28151
5e. Telephone no.: 704-480-9044
5f. Fax no.: 704-480-5401
5g. Email address: [e-mail]
Page 2 of 11
PCN Form -Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): NA
Latitude: 35.7816397 Longitude: -
1 b. Site coordinates (in decimal degrees): 80.9838292
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: <10 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Back 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:
Existing 36", 60 ft CMP. Designated landuse is cropland and pasture. Pipe is on paved secondary road.
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:
80
3d. Explain the purpose of the proposed project:
The purpose of the proposed work is to replace a deteriorating pipe for the safety of the travelling public.
3e. Describe the overall project in detail, including the type of equipment to be used:
NCDOT proposes to replace a deteriorating 36" x 60-foot CMP with a 54", 60-foot CMP with inlet and outlet headwalls.
Five feet of Class II riprap will be used at the pipe inlet and outlets for structural stabilization.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past? ? Yes ® No ? Unknown
Comments: Jurisdictional stream determination made by
Division 12 DEC.
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?
5b. If yes, explain in detail according to "help file" instructions.
Page 3 of 11
PCN Form -Version 1.3 December 10, 2008 Version
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 4 of 11
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. 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. 21b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
? Yes ? Corps
W1 ? P ? T ? No ? DWQ
? Yes ? Corps
W2 ? P ? T ? No ? DWQ
? Yes ? Corps
W3 ? P ? T ? No ? DWQ
? Yes ? Corps
W4 ? P ? T ? No ? DWQ
? Yes ? Corps
W5 ? P ? T ? No ? DWQ
? Yes ? Corps
W6 ? P ? T ? No ? 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. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ - non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 ®P ? T Structure
stabilization Ut to Back Creek ? PER
® INT ® Corps
® DWQ 1.5 10
Cofferdam bypass ? PER ® Corps
S2 ? P ® T pumping(if Ut to Third Creek ®INT ®DWQ 1.5 10
necessary)
? PER ® Corps
S3 ? P ? T ? INT ® DWQ
? PER ? Corps
S4 ? P ? T ? INT ? DWQ
? PER ? Corps
S5 ? P ? T ? INT ? DWQ
? PER ? Corps
S6 ? P ? T ? INT ? DWQ
3h. Total stream and tributary impacts 20
3i. Comments:
Page 5 of 11
PCN Form - Version 1.3 December 10, 2008 Version
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 individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Temporary T

01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
sf. Total
5g. Comments:
51h. 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):
5k. 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 mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse ?Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6-c 6d. 6e. 6f. 6g.
Buffer impact
number- Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T impact required?
?Yes
B1 ?P?T ? No
?Yes
B2 ?P?T ? No
?Yes
B3 ?P?T ? No
bh. Total buffer impacts
6i. Comments:
Page 6 of 11
PCN Form - Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The new pipe is to be placed along the existing streambed grade to prevent possible destabilization impacts to a pond dam
located directly upstream of the roadway
11b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Minimization of impacts by installing appropriate erosion control measures.
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

El 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
4f. Non-riparian wetland mitigation requested: acres
49. 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 7 of 11
PCN Form - Version 1.3 December 10, 2008 Version
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 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. 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).
6h. Comments:
Page 8 of 11
PCN Form - Version 1.3 December 10, 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? If no, explain why.
? Yes ? No
Comments:
2. Stormwater Management Plan

2a. What is the overall percent imperviousness of this project? 0%
2b. Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Complies with NCDOT's individual
NPDES permit NCS000250.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review

3a. In which local government's jurisdiction is this project? NA
? Phase II
El NSW
3b. Which of the following locally-implemented stormwater management programs ? USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review
? Coastal counties
? HQW
4a. Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply): ? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
? Yes ? No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No
5b. Have all of the 401 Unit submittal requirements been met? ? Yes ? No
Page 9 of 11
PCN Form - Version 1.3 December 10, 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?
1b. 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 2B .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.
The project is a minimum criteria project which has low potential for cumulative/indirect impacts and will not result in
additional development which could impact water quality.
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 10 of 11
PCN Form - Version 1.3 December 10, 2008 Version
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?
? 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?
NC Natural Heritage Program database.
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?
No salt marshes, oyster reefs, or seagrass beds in the vicinity of the project.
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?
The State Historic Preservation office resources and the National Register of Historic Places were reviewed for historic
sites in the vicinity of the project; however, the pipe replacement project occurs within a previously impacted area
(NCDOT Right of Way).
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:
8c. What source(s) did you use to make the floodplain determination? FEMA FIRM panel number: 370313 01000J
10. L l-(ol tale r I// 'b`y'/.c?? ? I o Z 0 0 ?
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)
Page 111 of 11
PCN Form -Version 1.3 December 10, 2008 Version
SR 1511, Watermelon Road
Iredell County
Downstream
Upstream (Pond Dam)

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Name: STATESVILLE WEST Location: 035.7816397° N 080.9838292' W
Date: 10/20/2009 Caption: SR 1511, Watermelon Road, UT to Back Creek, Class C
Scale: 1 inch equals 1000 feet Waters, Yadkin River Basin
Copyright (C) 1998, Maptech, Inc
Pipe Replacement
SR 1511, Watermelon Road
Iredell County
US 64
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Vicinity Map
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Notes:
Spike set in PP for
D Pumping Station to be used to Q a TBM. Assume Elev
divert the stream around the to be 100.0'
construction site as needed.
2) Any contaminated water within
the construction site is to be
pumped Into a silt bag.

O

N

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Marked Waterline \

Proposed 54'CMP 60'Long with
s
Drainage Ditch Headwalls on both ends
• \ Proposed Silt Fence
? k
Pool Areas
k
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Proposed Silt Fence J Unnamed Tributary
\ 5' to Back Creek
s
Approx Top of Dam •, Existing 36' CMP
Approx 60'Long
L/1 to be removed
Drainage Ditch
T
LP
3l Sllt fence to be placed around
stock pile and project as it allows
4l Upon completion of the project all
silt fences are to be placed as
needed. Also seeding and mulching
of disturbed areas.
5) Refer to section 4.2 of the BMP
marval 'Pipe/Culvert Installation.
This will severe as a good E&SC & pipe
installation schedule. It will also
let the crews know that the dike is to
be animpervious dike for the pump around.
NCDOT 12th Div
B)Class 11 or Shot Rock to be placed
Bridge Maintenance
0 all four corners of the headwall
not to exceed more than 5' along the
SR 1511 Watermelon Rd
channel
IredellCo N. Carolina
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NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division: 1? County: Iredell Project ID: 12b.20491 I
River Basin: Yadkin Bridge No: NA
Route: SR-1511
Stream: Ut to Back Creek
Water Quality Criteria:
Yes No
Stream Crossing Blue Line On USGS r r
ORW ? r
WS1 r r
WS 11,111 OR IV, Crossing Within 0.5mi of W.S. Critical Area ? G
Roadway Criteria:
Route Designation-
Additional Site Information:
Arterial Urban
Arterial Rural
Is a Hazardous Spill Basin Required?
Yes No
r w.
r P
Yes No
C r
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997).