20191758 Ver 1_Application Attachments_20191231

Water ResourcesENTAL QUALITY
A. Owner/Applicant Information
For instructions on how to fill out this form, see the Buffer Authorization Application Help Document posted on DWR's 401 & Buffer page.
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all mandatory questions are answered.
A. Owner/Applicant Information
General Information
Primary Contact Email: *
Is this project a public transportation
project? *
[e-mail]
Rease list the contact person's enail for questions or payrrent on this project if needed.
r Yes
r No
Who is submitting the application?* r- Owner
rJ Applicant other than Owner
r- Agent
Check all that apply
Is there an agent working on this application r Yes
but not submitting it?* r No
1. Property Owner Information:
la. Name on Recorded Deed:*
1b. Responsible Party:
1c. Mailing Address:*
1d. Telephone:* [phone]
NCDOT Right -of -Way SR 1159 Flat Swamp
Road in Martin County
Paul Williams
(for Corporations)
Street Address
113 Airport Dr.
Address Line 2
City
State / Frovince / Region
Edenton
NC
Fbstal / Zip Code
Country
27932
USA
2. Applicant's Information (if different from owner):
2a. Name:* Paul Williams
le. Email Address:* [e-mail]
2b. Company Affiliation: NC Department of Transportation

2c. Mailing Address:*
2d. Telephone:*
2e. Email Address:*
Street Address
113 Airport Dr.
Address Line 2
aty
Edenton
Fbstal / Zip Code
27932
[phone]
[e-mail]
State / Frovince / Fbgion
NC
Country
USA
If the applicant is not the property owner, in addition to providing the Agent's information, select Applicant other than Owner' above, enter the applicant's
information, and attach an authorization granting the applicant owner approval.

B. Project Information and Prior Project History
B. Project Information and Prior Project History
1. Project Information
u
la. Name of Project:* Bridge 71 Replacement Project in Martin County
(Subdivision, facility, or establishment narre)
If your project has a formal name please use this. If your project does not have a formal name, please identify your project by the owner name and
proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses any other names that have been used to identify the
project in the past.
1b. Is this a publicly -funded transportation project?*
r Yes
r No
1c. TIP# 17BP.1.R.86
1d. Subdivision Name: n/a
le. Nearest Robersonville
Municipality:
1f. Property Size: 1.00
acres
1g. County (or Counties) where the project is located:*
Martin
1h. Property ID# Date of Purchase
Tax RN or Parcel id
1 i. Deed Information
Type of Book Book# Page#
Deed
Map =F
1j. Attach a copy of the recorded map that indicates when the lot was last platted.
Click the upload button or drag and drop files here to attach docurrent
R7F only
1k. How would you like to provide the Latitude and Longitude information?*
f Address Lookup
r Manually
Latitude * 35.815905 Longitude *-77.264146
11. Is the project located in any of North Carolina's twenty coastal counties?
r Yes
r No
Coastal Management information can be found at:
About Coastal Management

• Staff Listing
o Coastal County Lookup
2. Surface Waters
2a. Name of the nearest body of water to proposed project:*
Flat Swamp
Link to Soil Surveys for North Carolina Counties. (Please see instructions in the Help Document to determine the most recent published version.)
2b. Water Quality Classification of nearest receiving water:*
C; Sw, NSW
2c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:*
100
(linear feet only)
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:
Project area consist of NCDOT Martin County SR 1159 and Bridge #71. The
adjacent property use is a mix of agricultural and timber.
3b. Attach an 8'/2 x 11 excerpt from the most recent version of the USGS topographic map indicating the location of the site.
Click the upload button or drag and drop files here to attach docunent
B-4577_QuadMap.pdf 2.66MB
FDF only
Link to TOPO Map lookup: https://viewer.nationalmap.gov/basic/
3c. Attach an 8 % x 11 excerpt from the most recent version of the published County NRCS Soil Survey Map depicting the
project site.
Click the upload button or drag and drop files here to attach docunent
Soil_Map.pdf
RDF only
622.51 KB
Link to Soil Surveys for North Carolina Counties. (Please see instructions in the Help Document to determine the most recent published version.)
4. Proposed Activity
Provide a detailed description of the proposed activity including its purpose and include the type of equipment to be used:*
The existing 52' L X25' W 3-span bridge will be removed and replaced with the
proposed 70' L X 33' W single span concrete cored slab bridge. The project will
result in no impacts to jurisdictional wetlands or streams. This work will be
accomplished using cranes, track excavators,backhoes, and dump trucks.
Attach a site plan as applicable to the project:
Click the upload button or drag and drop files here to attach docurrent
17BP.1.R.86_Permit Drawings_07302019.pdf 1.21MB
17BP.1.R.86_Permit Drawings_Buffer_07302019.pdf 779.68KB
RDF only
** Below is a link with instructions on what you will need to show on your site plan.
http://edocs.deq. nc.gov/WaterResou rces/0/doc/402224/Page l .aspx
5. Jurisdictional Determinations
5a. Have jurisdictional wetlands or stream determinations by the Corps or State been requested or obtained for this
property/project (including all prior phases) in the past?*
h
h

r Yes
r No
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
r Yes
r No
7. Future Project Plans
.............. ............... .............. ...............
7a. Is this project a phased project?* r Yes
r No

C. Proposed Impacts Inventory
C. Proposed Impacts Inventory ^,
...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................-...........
Buffer Impacts
1a. Project is in which protected Basin?*
r Neuse River Basin (15A NCAC 02B.0233)
f Catawba River Basin (15A NCAC 02B.0243)
r Randleman Lake Watershed (15A NCAC 02B.0250)
r Tar -Pamlico River Basin (15A NCAC 02B.0259)
r Jordan Lake Watershed (15A NCAC 02B.0267)
r Goose Creek Watershed (15A NCAC 02B.0606 & 15A NCAC 0213.0607)
You can find which river basin you live in at the link below.
http://wmw.eenorthcarolina.org/riverbasins-gis-map.asp
1c. Individually list all buffer impacts below. If any impacts require mitigation, then you MUST fill out Section D of this form.
Please note: if the impact you list below requires mitigation choose "allow w/ mitigation" under impact type.
Site# -Reason
Stream Name
Buffer Impact*
Impact Type *IF
Zone 1
Zone 2
Bridge
Flat Swamp
Permanent
Allowable
1,219.
0.00
K/hp label (e.g. Road
(P)
00
Square
Crossing 1)
Perm orTerrp
Square
Feet
Feet
Road Crossing
Flat Swamp
Permanent
Allowable
887.00
1,209.
fvhp label (e.g. Fbad
(P)
Square
00
Crossing 1)
Perm orTerrp
Feet
Square
Feet
Total Zone 1 Impacts: 2,106.00
Total Zone 2 Impacts: 1,209.00
Total Buffer Impacts: 3,315.00
Comments:
Buffer impacts depicted on attached document 17BP.1.R.86_Permit
Drawing s_Buffer_07302019

D. Impact Justification and Mitigation
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project.*
Bridge replacement will stay on the existing alignment and traffic will be detoured
around the site by using an offsite detour. This will reduce temporary impacts to
open waters by not utilizing an on -site detour and keeping the road open. Impacts to
jurisdictional wetlands and streams have been avoided.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
NCDOT BMP's will be followed during bridge removal/installation and erosion control
devices will be installed to prevent sediment loss from the project site.

E. Diffuse Flow Plan
E. Diffuse Flow Plan
All buffer impacts & high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a state implemented
riparian buffer program, upload a plan that fully documents howdiffuse flowwill be maintained. All stormwater control measures (SCMs) must be
designed in accordance with the NC Stormwater Design Manual. Associated supplement forms and other documentation must be provided.
For a list of options to meet the diffuse flow requirements, click here.
la. What type of SCM are you providing?*
I- Level Spreader
r% Vegetated Conveyance (lower SHWT)
r Wetland Swale (higher SHWT)
r Proposed project will not create concentrated stormwater flow through the
buffer
r Other SCM that removed minimum of 30% nitrogen
1 c. Diffuse Flow Documentation* (lick the upload button or drag and drop files here to attach docurrent
17BP.1.R.86_Permit Drawings_Buffer_07302019.pdf 779.68KB
FOF only

F. Supplementary Information
F. Supplementary Information
Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?
r Yes
r No
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 (North Carolina) Environmental Policy Act (NEPA/SEPA)?
r Yes
r No
Violations
2a. Is the site in violation of DWR Wetland Rules (15A NCAC 02H .0500), Isolated Wetland Rules (15A NCAC 02H .1300), DWR
Surface Water or Wetland Standards, or Riparian Buffer Rules (15A NCAC 02B .0200)?
r Yes
f• No
2b. Is this an after -the -fact buffer authorization application?
r Yes
r No
G. Additional Information ^
Please upload any additional information you would like the Division to consider during application review.
Additional Attachments: Click the upload button or drag and drop files here to attach docurrent
FDF only
Additional Comments:
Met onsite with Kyle Barnes, US Corps of Engineers, on 11/1/2019 to verify project
would not impact adjacent wetlands.

G. Sign and Submit
G. Sign and Submitt ^
By digitally signing below, I certifythat:
o I have given true, accurate, and complete information on this form;
o I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act')
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act');
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
• I intend to electronically sign and submit the application form."
Print Name:* Paul Collins Williams, Jr.
Signature *
C:'?W/4:-dI , 411r1-,,. Cam.
Submission Date: 12/30/2019
(Auto populated field)