20200200 Ver 1_BR-0123 CE 2019-08-06_20200206

DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
Type I and II Ground Disturbing Categorical Exclusion Action Of
Classification Form
Project No.
WBS Element
BR-0123
48832.1.1
Federal Project No. N/A
A. Project Description:
The North Carolina Department of Transportation (NCDOT) proposes to replace Bridge No.
850318 on SR 1319 (Abe Mayes Road) over Unnamed Tributary (UT) of South Fork Mitchell
River in Surry County in Division 11 (Refer to Figure 1).
Built in 1960, Bridge No. 850318 has a 15-foot travel lane that is one lane with two-way travel.
The bridge is approximately 26 feet in length and has a timber floor on I -beams construction.
Bridge No. 850318 has a posted Single Vehicle weight limit of 23 tons and a Truck Tractor
Semitrailer weight limit of 31 tons. Abe Mayes Road is an unpaved two-lane road
approximately 18 feet wide. The existing right of way along Abe Mayes Road is 18 feet. The
bridge approach ties into the intersection with SR 1318 (Oscar Calloway Road) and minor
construction along Oscar Calloway Road is proposed. Oscar Calloway Road is unpaved and
has two 10-foot travel lanes with an existing right of way of 25 feet. The project is scheduled
for Right of Way (ROW) in August 2019 and Let in April 2020. Minor ROW acquisition is
anticipated.
The project proposes replacing the existing two-lane bridge structure with an approximately
33-foot wide structure with two 10-foot travel lanes and 4-foot 11-inch paved shoulders. The
proposed bridge would be approximately 37 feet in length and the proposed right of way is 80
feet. The total length of the project is approximately 162 feet. The proposed design along
Oscar Calloway Road includes two 10-foot travel lanes with shoulders and guardrails. The
proposed right of way along Oscar Calloway Road ranges from approximately 45 feet to 65
feet. The proposed bridge will not be posted and will be designed to meet the legal load rating.
The bridge replacement would be constructed in place using an off -site detour. Abe Mayes
Road is classified as a Rural, Local Route with a 25-mile per hour design speed.
B. Description of Need and Purpose:
The replacement of Bridge No. 850318 is part of the Growing Rural Economy and Agriculture
through Transportation and Technology Enhancement or Replacement in North Carolina
(GREATTER-NC) Project under the United States Department of Transportation's 2018 Better
Utilizing Investments to Leverage Development (BUILD) Grant program. The purpose of the
grant and this bridge replacement project is to provide transportation infrastructure to support
economic development and improve physical and digital connectivity in rural communities in
North Carolina. The posted weight restriction on Bridge No. 850318 prohibits large or heavy
vehicles, typically used in transporting agricultural and manufactured products, from using the
bridge. Vehicles above the posted weight must detour approximately 3.5 miles to avoid the
bridge. Replacing the existing bridge will eliminate posted weight limits by providing a safe
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DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
crossing for all legal loads and will make accommodations for broadband installation in order to
support economic competitiveness.
NCDOT Structures Management Unit records indicate Bridge No. 850318 has a sufficiency
rating of 84.86 out of a possible 100 and has a posted weight limit. The proposed project will be
designed to meet the legal load rating.
C. Categorical Exclusion Action Classification:
❑X TYPE I A
❑ TYPE I B
❑
TYPE II A
❑
TYPE IIB
D. Proposed Improvements:
28. Bridge rehabilitation, reconstruction, or replacement or the construction of grade
separation to replace existing at -grade railroad crossings, if the actions meet the
constraints in 23 CFR 771.117(e)(1-6).
E. Special Proiect Information:
Anticipated Permit or Consultation Requirements: A Nationwide Permit (NWP) No. 3-
Maintenance and/or NWP No.14- Linear Transportation Projects will likely be applicable. The
US Army Corps of Engineers (USACE) holds the final discretion as to what permit will be
required to authorize project construction. A Section 404 permit is required and a
corresponding Section 401 Water Quality Certification (WQC) from the NC Department of
Environmental Quality- Division of Water Resources (NC DEQ- DWR) is needed.
Floodplain: Unnamed Tributary (UT) of South Fork Mitchell River, which crosses under Bridge
No. 850318, is in a FEMA Zone AE Floodplain. The Hydraulics Unit will coordinate with the NC
Floodplain Mapping Program (FMP), regarding applicability of NCDOT'S Memorandum of
Agreement, or approval of a Conditional Letter of Map Revision (CLOMR) and subsequent final
Letter of Map Revision (LOMR). This is noted in the greensheet/project commitments.
Historic and Archaeological Resources: In compliance with NCDOT's Programmatic
Agreement with the State Historic Preservation office, a No National Register of Historic
Places Eligible or Listed Archaeological Sites Present Form for Archaeological Resources was
completed by NCDOT on 05/03/2019. On 03/25/2019, NCDOT completed a No Survey
Required Form for Historic Architecture and Landscapes.
Agricultural Land Use: Based on the site visit (04/17/2019), aerial imagery, and local planner
input, it appears there is agricultural land use surrounding the project study area, primarily hay
production and poultry houses. Farming operations in the vicinity of the bridge may be affected
temporarily during construction by losing direct access and by using the approximately 3.5-mile
detour route. Continued coordination should occur through the NCDOT right of way acquisition
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DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
process with the owners of the agricultural lands that are temporarily impacted by the off -site
detour. This is noted in the greensheet/project commitments.
Environmental Commitments: Greensheet/Project commitments are located at the end of the
checklist.
Estimated Costs (Pending): The estimated costs, dated July 2018, are as follows:
Utility*
$
13,000
R/W*
$
13,000
Const.*
$
325,000
Total
$
351,000
*Source: NCDOT Connect GREATTER Rural Bridge Program- Bridges Budget Sources and Uses, Accessed June 11, 2019.
https://con nect. ncdot.gov/resources/G REATTER-Ru ral-Bridge-Program/Documents/05%20 N C DOT%2OB ridges%20 Budget%2OSources%20and%2OUses. xlsx
Estimated Traffic:
Average Daily Traffic (ADT) 2015 290 vehicles per day (vpd)
ADT 2040 580 vpd
Crashes: NCDOT's Safety Planning Group completed a planning level query of bridge crash
counts from 1/1/2013 to 12/31/2017. Over the five-year study period, zero crashes were
reported within a 500 feet distance of Bridge No. 850318 on Abe Mayes Road.
Pedestrian and Bicycle Accommodations: There are no existing bike and pedestrian
facilities on Bridge No. 850318 along Abe Mayes Road.
Design Exceptions: There are no anticipated design exceptions for this project.
Alternative Analysis:
No Build — The no build alternative would not meet the requirements of the GREATTER-NC
Project, and thus is not a viable option.
Rehabilitation — Rehabilitation would not meet the requirements of the GREATTER-NC Project,
and thus is not a viable option.
Onsite Detour — An offsite detour was determined acceptable.
New Alignment — A new alignment option for Abe Mayes Road was not considered due to the
acceptable offsite detour route which allows for the proposed bridge to be constructed in place.
Replace Bridge in Place with Offsite Detour (Preferred Alternative) — The bridge will be
replaced in place. The detour route is approximately 3.5 miles long and follows SR 1320 (Wolfe
Road), SR 1301 (Union Hill Road), and SR 1318 (Oscar Calloway Road).
Agency Comments: Input forms were sent to the Surry County Emergency Services Director,
Surry County Planning and Zoning Planning Director, and the Surry County Schools Director of
Transportation in February of 2019.
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DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
The Surry County Planning and Zoning Planning Director noted agricultural activities present in
the vicinity of the project and that these activities were typical of all rural areas of the county. A
moderate level of impact was noted from Surry County Planning and Zoning Planning Director if
the bridge was closed for up to a year. The Surry County Schools Director of Transportation
noted a bus crossing the bridge about once a week, but no buses crossing the bridge daily. A
low level of impact was noted from the Surry County Schools Director of Transportation if the
bridge was closed for up to a year. No response was received from the Surry County
Emergency Services Director after multiple contact attempts.
Agency Start of Study notifications were sent to the US Army Corps of Engineers (USACE),
US Fish and Wildlife Service (USFWS), NC Department of Environmental Quality -
Division of Water Resources (NC DEQ- DWR), NC Wildlife Resources Commission (NC
WRC), Federal Highway Administration (FHWA), NC Division of Parks and Recreation
(NC DPR), and the Catawba Indian Nation Tribal Historic Preservation Office (THPO) in
May and June of 2019. Start of Study notification were also sent to NCDOT Division 11 and
NCDOT Preconstruction contacts provided by NCDOT Structure Management Unit (SMU) in
May 2019.
The US Fish and Wildlife Service (USFWS) provided general comments regarding general
recommendations for replacing structures that cross rivers and streams, erosion and sediment
control, Northern Long-eared Bats (NLEB), and migratory birds. The project specific comments
provided by USFWS include surveying for Helianthus schweinitzii (Schweinitz's sunflower),
assessing habitat for Isotria medeoloides (Small whorled pogonia), and recommend winter tree
clearing for NLEB.
The NC Department of Environmental Quality- Division of Water Resources provided
general project comments but did not state any project specific comments. The general
comments regarded the North Carolina Department of Transportation Stormwater Best
Management Practices Toolbox, sediment and erosion control, structure type, wetland and
stream impacts, and 401 Water Quality Certification. The US Army Corps of Engineers and
NC Division of Parks and Recreation had no specific concerns for the project. No responses
were received from the NC Wildlife Resources Commission and Catawba Indian Nation
THPO at this time.
Public Involvement: A landowner notification letter was sent on 2/7/2019 to all property owners
affected directly by this project to inform them of representatives being present on their property.
The letter stated the following, "Please note that if the U.S. Army Corps of Engineers has
already issued a Jurisdictional Determination on your property confirming the presence of
streams and/or wetlands, or if you have general questions or comments about the project,
contact David Stutts at dstutts(@__ncdot.gov or [phone]." No comments have been
received to date.
Prior to ROW acquisition, newsletters will be sent out by NCDOT to the properties affected by
the project to inform them of the project and the offsite detour. This is noted in the
greensheet/project commitments.
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DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
F. Project Impact Criteria Checklists:
Type I & II - Ground Disturbing Actions
FHWA APPROVAL ACTIVITIES THRESHOLD CRITERIA
If any of questions 1-7 are marked "yes" then the CE will require FHWA approval.
Yes
No
1
Does the project require formal consultation with U.S. Fish and Wildlife
❑
Service (USFWS) or National Marine Fisheries Service (NMFS)?
2
Does the project result in impacts subject to the conditions of the Bald and
❑
Golden Eagle Protection Act (BGPA)?
3
Does the project generate substantial controversy or public opposition, for any
❑
reason, following appropriate public involvement?
4
Does the project cause disproportionately high and adverse impacts relative to
❑
❑X
low-income and/or minority populations?
5
Does the project involve a residential or commercial displacement, or a
❑
substantial amount of right of way acquisition?
6
Does the project require an Individual Section 4(f) approval?
❑
❑X
Does the project include adverse effects that cannot be resolved with a
7
Memorandum of Agreement (MOA) under Section 106 of the National Historic
❑
Preservation Act (NHPA) or have an adverse effect on a National Historic
Landmark (NHL)?
If any of questions 8 through 31 are marked "yes" then additional information will be required for those
questions in Section G.
Other Considerations
Yes
No
Does the project result in a finding of "may affect not likely to adversely affect"
8
for listed species, or designated critical habitat under Section 7 of the
❑
❑X
Endangered Species Act (ESA)?
9
Is the project located in anadromous fish spawning waters?
❑
0
Does the project impact waters classified as Outstanding Resource Water
10
(ORW), High Quality Water (HOW), Water Supply Watershed Critical Areas,
❑
0
303(d) listed impaired water bodies, buffer rules, or Submerged Aquatic
Vegetation (SAV)?
11
Does the project impact waters of the United States in any of the designated
❑
mountain trout streams?
12
Does the project require a U.S. Army Corps of Engineers (USACE) Individual
❑
IX
Section 404 Permit?
13
Will the project require an easement from a Federal Energy Regulatory
❑
0
Commission (FERC) licensed facility?
14
Does the project include a Section 106 of the NHPA effects determination
❑
0
other than a no effect, including archaeological remains?
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DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
Other Considerations (continued)
Yes
No
15
Does the project involve hazardous materials and/or landfills?
❑
Q
Does the project require work encroaching and adversely affecting a
16
regulatory floodway or work affecting the base floodplain (100-year flood)
❑
elevations of a water course or lake, pursuant to Executive Order 11988 and
23 CFR 650 subpart A?
Is the project in a Coastal Area Management Act (CAMA) county and
❑
17
substantially affects the coastal zone and/or any Area of Environmental
Concern (AEC)?
18
Does the project require a U.S. Coast Guard (USCG) permit?
❑
0
19
Does the project involve construction activities in, across, or adjacent to a
❑
designated Wild and Scenic River present within the project area?
20
Does the project involve Coastal Barrier Resources Act (CBRA) resources?
❑
0
21
Does the project impact federal lands (e.g. U.S. Forest Service (USFS),
❑
USFWS, etc.) or Tribal Lands?
22
Does the project involve any changes in access control?
❑
0
23
Does the project have a permanent adverse effect on local traffic patterns or
❑
community cohesiveness?
24
Will maintenance of traffic cause substantial disruption?
❑
0
Is the project inconsistent with the STIP or the Metropolitan Planning
25
Organization's (MPO's) Transportation Improvement Program (TIP) (where
❑
❑
applicable)?
Not Applicable
Does the project require the acquisition of lands under the protection of
Section 6(f) of the Land and Water Conservation Act, the Federal Aid in Fish
26
Restoration Act, the Federal Aid in Wildlife Restoration Act, Tennessee Valley
❑
Authority (TVA), or other unique areas or special lands that were acquired in
fee or easement with public -use money and have deed restrictions or
covenants on the property?
27
Does the project involve Federal Emergency Management Agency (FEMA)
❑
buyout properties under the Hazard Mitigation Grant Program HMGP ?
28
Does the project include a de minimis or programmatic Section 4(f)?
❑
0
29
Is the project considered a Type I under the NCDOT's Noise Policy?
❑
0
30
Is there prime or important farmland soil impacted by this project as defined by
❑
the Farmland Protection Policy Act FPPA ?
31
Are there other issues that arose during the project development process that
❑
affected the project decision?
G. Additional Documentation as Required from Section F
Response to Question 1: NCDOT has determined that the proposed action does not require
separate consultation on the grounds that the proposed action is consistent with the final
Section 4(d) rule, codified at 50 C.F.R. § 17.40(o) and effective February 16, 2016. NCDOT
may presume its determination is informed by best available information and consider Section
7 responsibilities fulfilled for NLEB.
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DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
Response to Question 8: A Natural Resources Technical Report (NRTR) was completed in
May of 2019 for this project and provided a biological conclusion of "Unresolved" for
Helianthus schweinitzii (Schweinitz's sunflower) and Isotria medeoloides (Small whorled
pogonia). Suitable habitats are present in the study area for both species and surveys will be
performed by Three Oaks Engineering during the USFWS Optimal Survey Windows. The
Survey Window for Helianthus schweinitzii (Schweinitz's sunflower) and Isotria medeoloides
(Small whorled pogonia) is late August thru October and mid -May thru early July, respectively.
A field visit and survey will be conducted for both species during the survey windows prior to
ROW and Construction. This is noted in the greensheet/project commitments.
Response to Question 16: This project involves construction activities on or adjacent to
FEMA-regulated stream(s). Therefore, the Division shall submit sealed as -built construction
plans to the Hydraulics Unit upon completion of project construction, certifying that the
drainage structure(s) and roadway embankment that are located within the 100-year floodplain
were built as shown in the construction plans, both horizontally and vertically.
The Hydraulics Unit will coordinate with the NC Floodplain Mapping Program (FMP), regarding
applicability of NCDOT'S Memorandum of Agreement, or approval of a Conditional Letter of
Map Revision (CLOMR) and subsequent final Letter of Map Revision (LOMR).
Response to Question 26 - Voluntary Agricultural District (VAD) Property: The northwest
and southwest quadrants of the bridge lie within a Surry County VAD property. The project
would require less than approximately 0.10 acres of right of way from the VAD parcel. If during
the right-of-way acquisition process, the VAD property holder refuses settlement, prior to
pursuing condemnation, the Division 11 Right of Way Agent must contact Environmental
Analysis Unit to coordinate with the Surry County VAD Board to schedule a public meeting.
The Surry County VAD ordinance provides that no state or local public agency or
governmental unit may formally initiate any action to condemn any interest in qualifying
farmland within a Surry County VAD until such agency or unit has requested the advisory
board to hold a public hearing on the proposed condemnation. The Surry County VAD
Program is administered by The Surry Soil and Water Conservation District. Farmland and
livestock were observed in the vicinity of the project on the field visit in April 2019. This is noted
in the greensheet/project commitments.
Response to Question 30 - Prime and Important Farmland Soils:
Prime and Important Farmland Soils as defined by the Farmland Protection Policy Act (FPPA)
are located within the project study area. A project footprint for the Prime and Important
Farmland Soils assessment was created to include a 25-foot buffer from estimated right of
way, based on the preliminary plans. The Prime and Important Farmland Soil found within the
footprint are designated as all areas are Prime Farmland (CsA).
A Natural Resource Conservation Service (NRCS) Farmland Conversion Impact Rating has
been completed for this project and a total score of 58 out of 160 points was calculated for the
BR-0123 project site. Since the total of the points assigned in part VI of the NRCS Farmlands
Conversion Form AD-1006 for BR-0123 is less than 60 and therefore the total points of the
NRCS Farmlands Conversion Form AD-1006 is less than 160, no mitigation for farmland loss
is required for the project in accordance with FPPA.
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DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
H.
Categorical Exclusion Approval
Project No.
WBS Element
Federal Project No.
Prepared By: DocuSigned by:
7/11/2019 i lk , saO
Date Eliza a 4gbott, EI,
BR-0123
48832.1.1
N/A
Engineers Inc.
Prepared For: North Carolina Department of Transportation
Reviewed By:
Signed by:
8/1/2019 Fp�irS.l "S) IN
Date i ip . arris, III, PE, Environmental Analy:
North Carolina Department of Transportation
nit
If all of the threshold questions (1 through 7) of
❑X Approved Section F are answered "no," NCDOT approves this
Categorical Exclusion.
❑ Certified
8/6/2019
Date
If any of the threshold questions (1 through 7) of
Section F are answered "yes," NCDOT certifies this
Categorical Exclusion.
—DocuSigned by:
s6t'p' -14�
Kevin Fischer, PE, Structures Management Unit
North Carolina Department of Transportation
FHWA Approved: For Projects Certified by NCDOT (above), FHWA signature
required.
N/A
Date John F. Sullivan, III, PE, Division Administrator
Federal Highway Administration
8 Updated 7/31/19

DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
I. Project Commitments
Surry County
Bridge No. 850318 on SR 1319 (Abe Mayes Road)
over UT of South Fork Mitchell River
WBS No. 48832.1.1
Project No. BR-0123
NCDOT Hydraulics Unit
FEMA Coordination
The Hydraulics Unit will coordinate with the NC Floodplain Mapping Program (FMP),
regarding applicability of NCDOT'S Memorandum of Agreement, or approval of a
Conditional Letter of Map Revision (CLOMR) and subsequent final Letter of Map
Revision (LOMR).
This project involves construction activities on or adjacent to FEMA-regulated stream(s).
Therefore, the Division shall submit sealed as -built construction plans to the Hydraulics
Unit upon completion of project construction, certifying that the drainage structure(s)
and roadway embankment that are located within the 100-year floodplain were built as
shown in the construction plans, both horizontally and vertically.
NCDOT Structures Management Unit
Unresolved Biological Conclusion
Surveys will be conducted for Helianthus schweinitzii (Schweinitz's sunflower) and
Isotria medeoloides (Small whorled pogonia) prior to project construction.
NCDOT Structures Management Unit
Public Involvement Newsletter
Prior to ROW, newsletters will be sent out on behalf of NCDOT to the properties
affected by the project to inform them of the project and the offsite detour.
NCDOT - Division 11
Agricultural Land Use
Farming operations in the vicinity of the bridge may be affected temporarily during
construction by losing direct access and by using the approximately 3.5-mile detour
route. Continued coordination should occur through right of way with the owners of the
agricultural lands that are temporarily impacted by the off -site detour.
NCDOT - Division 11
Voluntary Agricultural District (VAD) Property
The northwest and southwest quadrants of the bridge lie within a Surry County VAD
property. The project would require less than approximately 0.10 acres of right of way
from the VAD parcel. If during the right-of-way acquisition process, the VAD property
holder refuses settlement, prior to pursuing condemnation, the NCDOT Right of Way
Agent must contact Environmental Analysis Unit to coordinate with the Surry County
VAD Board to schedule a public meeting. The Surry County VAD ordinance provides
that no state or local public agency or governmental unit may formally initiate any action
to condemn any interest in qualifying farmland within a Surry County VAD until such
agency or unit has requested the advisory board to hold a public hearing on the

DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
proposed condemnation. The Surry County VAD Program is administered by The Surry
Soil and Water Conservation District.
NCDOT Division 11
Continued Coordination for Schools and Emergency Services
NCDOT should coordinate with Surry County Schools (Rodney Hardy, 336-386-8762)
and Surry County Emergency Services (John Shelton, 336-783-9000) at least one
month prior to construction.

DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
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THIS PROJECT IS NOT WITHIN ANY MUNICIPAL BOUNDARIES.
CLEARING ON THIS PROJECT SHALL BE PERFORMED
TO THE LIMITS ESTABLISHED BY METHOD _
SURRY COUlTY
LOCATION: BRIDGE #318 OVER POLE BRIDGE CREEK
ON SR 1319 (ABE MA YES RD)
TYPE OF WORD: GRADING, DRAINAGE, PA TVING, & STRUCTURE
STATE
STATE PROJECT REFERENCE NO.
SHEET
NO.
TOTAL
SHEETS
N.C.
BR-0123
1
STATE PROJ. NO.
F. A. PROD. NO.
DESCRIPTION
67123.1.1
P.E.
INCOMPLETE PLANS
D® NOT USE FOR R % W ACQUISITION
DOCUMENT NOT CONSIDERED FINAL
UNLESS ALL SIGNATURES COMPLETED
GRAPHIC SCALES
50 25 0 50 100
DESIGN DATA
ADT 2 015 = 290
ADT 2040 = N /A
D H V = N/ A
D = N / A
T = N /A
V = 2 5 MPH
FUNC. CLASSIFICATION:
LOCAL
SUB —REGIONAL TIER
"11111
PROJECT LENGTH
',
LENGTH OF ROADWAY TIP PROJECT BR-0123 = 0.024 MILES
LENGTH OF STRUCTURE TIP PROJECT BR-0123 = 0.007 MILES
TOTAL LENGTH OF TIP PROJECT BR-0123 = 0.031 MILES
PLANS PREPARED FOR THE NCDOT BY:
STV Engineers, Inc.
K?/6,STV 100 900 West Trade St., Suite 715
NCaLtenseNNumbe02F-0991
HYDRAULICS
ENGINEER
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2018 STANDARD SPECIFICATIONS
NIKKI T. HONEYCUTT, PE
PLANS
50 25 0 50 l00
RIGHT OF WAY DATE:
AUGUST 15, 2 01 9
SIGNATURE:
ROADWAY
DESIGN
ENGINEER
P.E.
PROJECT ENGINEER
BHUPESH R. JOSHI, EIT
PROFILE (HORIZONTAL)
10 5 0 10 20
LETTING DATE:
APRIL 17, 2020
NCDOT CONTACT: TIERRE PETERSON, PE
Structures Management Unit
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DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
Project Tracking No.
18-09-0085
NO NATIONAL REGISTER OF HISTORIC PLACES
oo ELIGIBLE OR LISTED ARCHAEOLOGICAL SITES
r�s)
PRESENT FORM A,
o
.. 0 ° This form only pertains to ARCHAEOLOGICAL RESOURCES for this project. It is not N
valid for Historic Architecture and Landscapes. You must consult separately with the
Historic Architecture and Landscapes Group.
PROJECT INFORMATION
Project No
WBS No:
F.A. No:
BR-0123
67123
Federal Permit Required?
County: Surry
Document: Federal Categorical Exclusion
Funding: ® State ❑ Federal
® Yes ❑ No Permit Type: USACE
Project Description:
Replace Bridge 318 on SR 1319 (Abe Mayes Rd.) over an unnamed tributary to the South Fork
Mitchell River in Surry County. The Area of Potential Effects (A.P.E.) is approximately 526
meters (1,725 ft.) long and 122 meters (400 ft.) wide. The A.P.E. includes land along SR 1319
(Abe Mayes Rd.) and SR 1318 (Oscar Calloway Rd.). The project is State -funded and will require
Federal permits. Easements will be required.
SUMMARY OF ARCHAEOLOGICAL FINDINGS
The North Carolina Department of Transportation (NCDOT) Archaeology Group reviewed
the subject project and determined:
® There are no National Register listed ARCHAEOLOGICAL SITES within the project's
area of potential effects. (Attach any notes or documents as needed.)
❑ No subsurface archaeological investigations were required for this project.
® Subsurface investigations did not reveal the presence of any archaeological resources.
❑ Subsurface investigations did not reveal the presence of any archaeological resources
considered eligible for the National Register.
❑ All identified archaeological sites located within the APE have been considered and all
compliance for archaeological resources with Section 106 of the National Historic
Preservation Act and GS 121-12(a) has been completed for this project.
Brief description of review activities, results of review, and conclusions:
The initial review included an examination of topographic maps, the Surry County soil survey, an
aerial photograph, and information about previously recorded archaeological sites, previous
archaeological surveys, and environmental reviews at the North Carolina Office of State
Archaeology (OSA) in Raleigh. The A.P.E. includes land along both SR 1319 and SR 1318. SR
1319 at the bridge is oriented approximately east -west. SR 1319 curves to the north a short
distance west of the bridge. SR 1319 intersects with SR 1318 a short distance east of the bridge.
SR 1318 is oriented approximately north -south.
"NO NATIONAL REGISTER ELIGIBLE OR LISTED ARCHAEOLOGICAL SITES PRESENT OR AFFECTED
form for Minor Transportation Projects as Qualified in the 2015 Programmatic Agreement.
lofll

DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
Project Tracking No.
18-09-0085
The topographic maps (Roaring Gap and Thurmond) show the landforms in the A.P.E. include
ridge toes overlooking two streams (South Fork Mitchell River and unnamed tributary), and level
floodplain along both streams. Level ridge toes overlooking streams can have a moderate to high
potential for archaeological sites, depending upon the distance from and elevation above the
stream. Level, well -drained floodplains have a moderate to high potential for prehistoric
archaeological sites.
The aerial photograph shows the land use in the A.P.E. is a mix of wooded and cleared. The
cleared land appears to be agricultural fields or pasture. There are a couple of buildings in the
A.P.E. (farm buildings?). There appears to be an automobile junk yard on the east side of SR 1319
at the north end of the A.P.E.
The information at the OSA shows there are no previously recorded archaeological sites within or
adjacent to the A.P.E. The A.P.E. is not within any areas that have been previously surveyed for
archaeological sites. A project located along SR 1318 within the A.P.E. has been reviewed by the
State Historic Preservation Office (HPO) (ER 04-2801). The project was improvements to SR
1318, and no archaeological survey was recommended.
The review recommended survey of the level, well -drained landforms adjacent to streams within
the A.P.E. on 10/26/2018. A reconnaissance of the project was conducted on 10/29/2018. The
reconnaissance found that only one part of the A.P.E. included a landform with potential for
archaeological sites.
The northwest quadrant of the A.P.E. includes land along the north side of SR 1319 and the west
side of the tributary stream. The landform in the northwest quadrant is a sloped ridge. The western
part of the quadrant is a ridge top, and the eastern part is a slope down from the ridge to the tributary
stream. The land in this quadrant is currently used as a hay field or pasture. There are several
farm buildings located along SR 1319 on the ridge.
The northeast quadrant includes land along the west and east sides of SR 1318 to the north of the
SR 1319 intersection. The landform along the west side of SR 1318 is a narrow strip of land
between the road and the tributary. The land is sloped from the road down to the narrow floodplain
along the creek. The floodplain appears to be an unstable landform that is prone to flooding. The
landform along the east side of SR 1318 is a slope up to the east. Both sides of SR 1318 are
wooded.
The southeast quadrant includes the land along the west and east sides of SR 1318 south of the SR
1319 intersection. The landform along the west side of SR 1318 is a narrow strip between the road
and the tributary. The tributary joins the South Fork Mitchell River near the south end of the
A.P.E. The landform along the east side of SR 1318 is a slope uphill to the east. The land along
the east side of the road is a mix of wooded and hay field/pasture.
The southwest quadrant includes the land along the south side of SR 1319 west of the bridge. The
landform in the southwest quadrant is a sloped ridge along the south and west sides of SR 1319,
and a narrow strip of floodplain along the west side of the tributary, and the north and south sides
of the South Fork. The land along SR 1319 in the west half of the quadrant is a ridge top.
"NO NATIONAL REGISTER ELIGIBLE OR LISTED ARCHAEOLOGICAL SITES PRESENT OR AFFECTED
form for Minor Transportation Projects as Qualified in the 2015 Programmatic Agreement.
2of11

DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
Project Tracking No.
18-09-0085
The survey focused on the floodplain located along the west side of the tributary and the north side
of the South Fork. This land is currently used as a hay field or pasture. The narrow floodplain is
located at the base of a ridge that slopes up to the north. The floodplain on the south side of the
South Fork is wooded, indicating that it may be unsuitable for hay field or pasture (due to poor
drainage?). (The Surry County soil survey indicates that the soil on both sides of the river is
Colvard and Suches soils [0-3% slopes], occasionally flooded, a well -drained soil found on levees
in floodplains.)
The archaeological survey consisted of the excavation of three shovel tests (STs) along the west
side of the tributary and the north side of the South Fork. None of the STs contained any artifacts.
No STs were excavated on the south side of the South Fork. ST 1 was placed approximately 20
meters (66 ft.) south of the bridge and 10 meters (33 ft.) west of the tributary. The soil consisted
of 45 centimeters (18 in.) of brown silty loam and silty clay with a heavy gravel content. ST 2 was
placed approximately 30 meters (100 ft.) south of ST 1, 5 meters (16 ft.) west of the tributary, and
20 meters (66 ft.) north of the South Fork. The soil consisted of 65 centimeters (26 in.) of brown
silty clay loam with very little rock content. ST 3 was placed approximately 30 meters (100 ft.)
west of ST 2 and 10 meters (33 ft.) north of the South Fork. The soil consisted of 25 centimeters
(10 in.) of brown silty loam with a heavy gravel content. The floodplain to the west of ST 3 was
a very narrow strip because the ridge toe extends almost to the South Fork, so no more STs were
excavated.
In conclusion, the archaeological survey of the A.P.E. did not identify any archaeological sites.
Most of the land in the A.P.E. has a low potential for archaeological sites. No further work is
recommended for this project.
SUPPORT DOCUMENTATION
See attached: ® Map(s) ❑ Previous Survey Info
Other:
Signed:
CALEB SMITH
NCDOT ARCHAEOLOGIST
® Photos ❑Correspondence
5/3/2019
Date
"NO NATIONAL REGISTER ELIGIBLE OR LISTED ARCHAEOLOGICAL SITES PRESENT OR AFFECTED
form for Minor Transportation Projects as Qualified in the 2015 Programmatic Agreement.
3ofII

DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
Project Tracking No. (In[errrad Use)
18-09-0085
r
t HISTORIC ARCHICTECTURE AND LANDSCAPES
NO HISTORIC PROPERTIES PRESENT OR AFFECTED FORM
1.
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:
BR-0123
County:
Surry
WBS No.:
67123.1.1
Document
T e:
CE
Fed. Aid No:
Funding:
State ❑ Federal
Federal
Permits :
❑ Yes ❑ No
Permit
Tye s
USAGE
Praiect Description:
Replace Bridge No. 318 on SR 1319 over UT to South Fork Mitchell River
SUMMARY OF HISTORIC ARCHICTECTURE AND LANDSCAPES REVIEW
There are no National Register -listed or Study Listed properties within the project's area of
potential effects.
There are no properties less than fifty years old which are considered to meet Criteria
Consideration G within the project's area of potential effects.
❑ There are no properties within the project's area of potential effects.
There are properties over fifty years old within the area of potential effects, but they do not
meet the criteria for listing on the National Register.
® There are no historic properties present or affected by this project. (Attach any notes or
documents as needed.)
Date of field visit: March 18, zoig
Description of review activities, results, and conclusions:
Review of HPD quad reaps, relevant background reports, historic designations roster, and indexes was
undertaken on October 18, 2019. Based on this review there are no NR, DE, LL, SL, or SS in the Area of
Potential Effects (APE). There are two clusters of farm buildings in the vicinity of the bridge. These
structures do not rise to the level of architectural integrity of significance to warrant further evaluation
for National Register eligibility. No historic properties will be affected by this project.
SUPPORT DOCUMENTATION
®Map(s) ❑ Previous Survey Info. ZPhotos ❑Correspondence ❑Design Plans
Historic Architecture and Landwapes NO H1,S7Olijc PROPEI 1IES PRESENT OR AFFECT EDjotnt for Minor Transporiation Projects as Qualified in the 2007
Programmatic Agreement.
Page: 1 of 6

DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
FINDING BY NCDOT ARCHITECTURAL HISTORIAN
Historic Architecture and Landscapes - NO HISTORIC PROPERTIES PRESENT OF AFFECTED
NCDOT Architectural Historian Date
Ilisioric Archiiechrre andLandscapes NO Transportation Projects as Quufified in the 2007
Prograrnmmic 11greesreni.
Page 2 of 6

DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
r i
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER
GOVERNOR
Date:
MEMORANDUM TO
From:
SUBJECT:
JAws H. TROGDON, III
SECRETARY
July 1, 2019
File
Michelle Lopez, Transportation Planner, STV Engineers,
Inc.
NRCS Farmland Conversion Impact Rating Bridge No. 850318 on SR 1319
(Abe Mayes Road) over Unnamed Tributary (UT) of South Fork Mitchell
River
Surry County, NC
WBS 67123.1.1, STIP Project No. BR-0123
The Farmland Protection Policy Act of 1981 (7 CFR Part 658) (FPPA) requires an assessment of
the potential impacts of land acquisition and construction activities in prime, unique, and local or
statewide importance as defined by the US Natural Resource Conservation Service (MRCS). This
memo is to document the completion and results of the NRCS Farmland Conservation Impact
Rating process for Project BR-0123 consistent with FPPA.
Project Description
BR-0123 proposes to replace Bridge No. 850318 on SR 1319 (Abe Mayes Road) over
Unnamed Tributary (UT) of South Fork Mitchell River in Surry County.
Applicability
Project BR-0123 is subject to the provisions of FPPA for the following reasons:
• It is a federally funded project.
• It is not within a municipality, urbanized area, or urban built-up area
• Prime farmlands and farmlands of statewide importance are found within the project area
• The land is not in water storage or used for national defense purposes
Mailing Address: Telephone: [phone]
NC DEPARTMENT OF TRANSPORTATION Fax: [phone]
Project Development and Environmental Analysis Website: www.ncdot.gov
1000 Birch Ridge Drive
1548 Mail Service Center
Raleigh, NC 27699-1548

DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
NRCS Farmland Figure
In accordance with guidance provided by NCDOT Community Studies, the farmland figure was
created to display the project location and a one -mile buffer over a layer displaying prime
farmland, farmland of statewide importance, and prime farmlands if drained located in the
vicinity of the project. A project footprint was created to include a 25-foot buffer from
estimated right of way. The NRCS farmland figure is attached to this memo.
Completion of Part VI of the NRCS Form AD-1006
Part VI (Site Assessment Criteria) of the NRCS Form AD-1006 was completed for this project.
Points allotted for each criterium and reasoning are provided below.
1. Area in Non -urban Use: 15 out of 15 points. Estimated using aerial
photography; approximately 100 percent of the land within the 1-mile buffer is
non -urban.
2. Perimeter in Non -urban Use: 10 out of 10 points. Estimated using aerial
photography; approximately 100 percent borders on land in non -urban use.
3. Percent of Site Being Farmed: 1 out of 20 points. Estimated using aerial photography,
approximately 5 percent of the project footprint site is being farmed.
4. Protection Provided by State and Local Government: 3 out of 20 points. A small
portion of the project footprint site is designated as a Voluntary Agriculture
District (VAD), but minimal impacts are anticipated.
5. Distance from Urban Built-up Area: 15 out of 15 points. Determined using aerial
photography; residential development is not within 10,560 feet of the project site.
6. Distance to Urban Support Services: 10 out of 15 points. County water and sewer
maps indicate services exist within'/z mile of the site. Some support services exist
within 3 miles of the project footprint site.
7. Size of Present Farm Unit Compared to Average: 2 out of 10 points. The farm unit is
more than 60 percent below the average size farm unit in Surry County (101 acres).
8. Creation of Non-farmable Farmland: 0 out of 10 points. The project will have
minimal implications on remaining farmable land.
9. Availability of Farm Support Services: 0 out of 5 points. No required services are
available in the project footprint site.
10. On -Farm Investments: 2 out of 20 points. Some on -farm investments including
waterways were identified using aerial imagery in the project footprint site.
11. Effects of Conversion on Farm Support Services: 0 out of 10 points. No significant
reduction in demand for support services is expected to result from the project.
12. Compatibility with Existing Agricultural Use: 0 out of 10 points. The project is
compatible with existing agricultural use.
Result of Site Assessment Criteria
The sum of the points assigned in part VI of the NRCS for AD-1006 for BR-0123 is 58.
Summary
Because the total of the points assigned in part VI of the NRCS for AD-1006 for BR-0123 is
more than 60 and therefore the total points of the NRCS Farmlands Conversion Form AD-1006
is less than 160, impacts to FFPA soils is anticipated and mitigation for farmland loss is required
for the project in accordance with FPPA.

DocuSign Envelope ID: A7C98BEE-578F-4C9A-9218-38DCB9473861
Sources
US Census. Census of Agriculture. 2012. County Data. North Carolina. Surry County. Accessed
6/25/2019.
(hqps://www.nass.usda.gov/Publications/AgCensus/2012/Online Resources/CoID1y Profiles/North_Carolina/cp37171.pdf)
Surry County. GIS and Mapping. www.gis.surryinfo.net. Accessed 6/25/2019.
(www.gis.sun-vinfo.net)
Legal Information Institute. Section 658.5- Criteria. Accessed 6/3/2019.
(hqps://www.law.comell.edu/cfr/text/7/658.5)
Attachments
NRCS Farmland figure
Cc: Harrison Marshall and Herman Huang, NCDOT Community Studies
jo

Appendix A

MEMORANDUM
DATE: 8/6/2019
TO: File
FROM: STV Engineers Inc
SUBJECT: BR-0123 CE
Documentation
FILE NUMBER: 4019918
PROJECT/PROP. NO.: BR-0123
CLIENT:
NCDOT Structures
Management Unit
The following documents were used in the preparation of the Categorical Exclusion for BR-0123.
-Historic Architecture and Landscapes No Historic Properties Present or Affected Form
(03/25/2019)
-Historic Architecture and Landscapes Survey Required Form (10/18/2018)
-No National Register of Historic Places Eligible or Listed Archaeological Sites Present Form
(05/03/2019)
-Local School Input (02/15/2019)
-Local Planner Input (03/26/2019)
-Natural Resource Technical Report (05/2019)
-Landowner Notification (02/07/2019)
-Section 7 survey results for the Northern Long-eared Bat (03/25/2019)
-Preliminary Jurisdictional Determination Package (PJD) (05/22/2019)
-Farmland Conversion Memo (07/01/2019)
-Demographic Memo (05/28/2019)
-Certification of Financial Contribution BUILD Grant Application (07/19/2018)
-Field Scoping Meeting Worksheet (04/17/2019)
-Structure Safety Report (12/13/2017)
-NCDOT Bridges Budget and Sources Used (2018)
-NCDOT Bridge Crash Count (2018)
-Bridge Traffic Review Sheet (10/02/2018)
-GeoEnvironmental Pre-Scoping Comments (06/27/2019)
-NCDOT Hydraulics Pre-Scoping Comments (05/08/2019)
-NCDOT Rail Pre-Scoping Comments (05/10/2019)
-North Carolina Division of Parks and Recreation (DPR) Pre-Scoping Comments (05/10/2019)
-US Fish and Wildlife Pre-Scoping Comments (06/05/2019)
-Screening Checklist (accessed 07/2019)

MEMORANDUM
PAGE 2 OF 2
-Pre-Screening Summary (08/30/2018)
-Division Resource Map (accessed 07/2019)

Project Tracking No. (Internal Use)
18-09-0085
am.r
HISTORIC ARCHICTECTURE AND LANDSCAPES
fa
NO HISTORIC PROPERTIES PRESENT OR AFFECTED 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:
BR-0123
County:
Surry
WBS No.:
67123.1.1
Document
Type:
CE
Fed. Aid No:
Funding:
® State ❑ Federal
Federal
Per :
®Yes ❑ No
Permit
Type s
USACE
P_roiect Description:
Replace Bridge No. 318 on SR 1319 over UT to South Fork Mitchell River
SUMMARY OF HISTORIC ARCHICTECTURE AND LANDSCAPES REVIEW
® There are no National Register -listed or Study Listed properties within the project's area of
potential effects.
® There are no properties less than fifty years old which are considered to meet Criteria
Consideration G within the project's area of potential effects.
❑ There are no properties within the project's area of potential effects.
® There are properties over fifty years old within the area of potential effects, but they do not
meet the criteria for listing on the National Register.
® There are no historic properties present or affected by this project. (Attach any notes or
documents as needed.)
Date of field visit: March 18, 2019
Description of review activities, results, and conclusions:
Review of HPO quad maps, relevant background reports, historic designations roster, and indexes was
undertaken on October 18, 2019. Based on this review there are no NR, DE, LL, SL, or SS in the Area of
Potential Effects (APE). There are two clusters of farm buildings in the vicinity of the bridge. These
structures do not rise to the level of architectural integrity of significance to warrant further evaluation
for National Register eligibility. No historic properties will be affected by this project.
SUPPORT DOCUMENTATION
®Map(s) ❑Previous Survey Info. ®Photos ❑Correspondence ❑Design Plans
Historic Architecture and Landscapes NO HISTORIC PROPERVES PRESENT OR AFF@CTED form for Miner Transpoiradon Projects as Qualified in the 2007
Programmatic Agreement.
Page 1 of 6

FINDING BY NCDOT ARCHITECTURAL HISTORIAN
Historic Architecture and Landscapes - NO HISTORIC PROPERTIES PRESENT OF AFFECTED
NCDOT Architectural Historian Date
Illstortc Architechrre andLandscapes NO HIS7(11i1C' 7'ROI'&1d77l ,S PRIiSls'N7' OR A11 I CT1iIl fnrara far M1liraar 7'ran.sportatiaaa Projects as QualifnW in Me 2007
ProRraraamatic Agreement
Page 2 of 6

Area i
Historic Architecture and Landvcuper NO WSfORK' PRPN'MUIES PRF..SFVT OR A!%FF.CTFD form for Projects as Qualified in the 2007
Programmatic Agreement
Wage 3 of 6

ME,
'Y �O
Ihsloric Amirilecture and LandscapesW) HISTORIC: PROPIll? 77FS PRESENT OR AFFA C TIM form for Almor Tran vporialion Prqteas aw Qualified ol the 2007
Programmatic Agmenica
Page 4 of 6

Area 2
Hislarie Archileclare andLandscapes andscapes NO HIS7'OPJC PROPB,RCIkS PRESiN1'OR A17<RC'7'B1J farm for• Alin" Dwnsparravvn Projects as Qualrfied in the 2007
PrugrammaNc Agreement
Page 5 of 6

Area 3
Bridge No. 307 no proposed for replacement as part of this project
Bridge No 318
Historic Archtteeture acid Lmidscapes NO HISTORIC PROPERTIES PRESENT OR AF%TCTFD forni for Minor Transportation Pr(yeas as Qualified iri the 2007
Pragrannnatic Agreement.
Page 6 of 6

Project Tracking No- (Internal Use)
18-09-0085
tc HISTORIC ARCHICTECTURE AND LANDSCAPES
,w "SURVEY REQUIRED 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:
BR-0123
County:
Surry
WBS No.:
67123.1.1
Document
Type:
MCC
Fed. Aid No:
Funding:
® State ❑ Federal
Federal
Permits :
® Yes ❑ No
Permit
T e s
USACE
Praiect Description:
Replace Bridge No. 318 on SR 1319 (Abe Mayes Rd) over UT to South Fork Mitchell River
SUMMARY OF HISTORIC ARCHICTECTURE AND LANDSCAPES REVIEW
Description of review activities results and conclusions:
On October 18, 2018 a search of NC HPOWEB GIS Service map reveals that there are
properties over 50 years of age in the Area of Potential Effects (APE) for this project. An
architectural historian will need to conduct a site visit to determine if the properties need
eligibility evaluations.
SUPPORT DOCUMENTATION
®Map(s) []Previous Survey Info. ®Photos ❑Correspondence ❑Design Plans
FINDING BY NCDOT ARCHITECTURAL HISTORIAN
Historic Architecture and Landscapes -- **SURVEY REQUIRED**
Shelby Reap
NCDOT Architectural Historian
Anticipated Fieldwork Completion Date: tba
October 18, 2018
Date
Historic Architecture and landscapes SURVEY REQUIRED form for Minor Transportation Projects as Qualified in the 2007 Prograinmalic Agreement.
Page 1 of 2

Hisforlc Archifechere ot?d Landscapes SURVEY R.LQUIREDformfor Minor Transportation Projects as Quaffed in the 2007 Programmatic Agreement.
Page 2 of 2

Project Tracking No.
18-09-0085
NO NATIONAL REGISTER OF HISTORIC PLACES
o� ELIGIBLE OR LISTED ARCHAEOLOGICAL SITES
C
PRESENT FORM o
This form only pertains to ARCHAEOLOGICAL RESOURCES for this project. It is not
valid for Historic Architecture and Landscapes. You must consult separately with the 4�`
Historic Architecture and Landscapes Group.
PROJECT INFORMATION
Project No
WBS No:
F.A. No:
BR-0123
67123
Federal Permit Required?
County: Surry
Document: Federal Categorical Exclusion
Funding: ® State ❑ Federal
® Yes ❑ No Permit Type: USACE
Project Description:
Replace Bridge 318 on SR 1319 (Abe Mayes Rd.) over an unnamed tributary to the South Fork
Mitchell River in Surry County. The Area of Potential Effects (A.P.E.) is approximately 526
meters (1,725 ft.) long and 122 meters (400 ft.) wide. The A.P.E. includes land along SR 1319
(Abe Mayes Rd.) and SR 1318 (Oscar Calloway Rd.). The project is State -funded and will require
Federal permits. Easements will be required.
SUMMARY OF ARCHAEOLOGICAL FINDINGS
The North Carolina Department of Transportation (NCDOT) Archaeology Group reviewed
the subject project and determined:
® There are no National Register listed ARCHAEOLOGICAL SITES within the project's
area of potential effects. (Attach any notes or documents as needed.)
❑ No subsurface archaeological investigations were required for this project.
® Subsurface investigations did not reveal the presence of any archaeological resources.
❑ Subsurface investigations did not reveal the presence of any archaeological resources
considered eligible for the National Register.
❑ All identified archaeological sites located within the APE have been considered and all
compliance for archaeological resources with Section 106 of the National Historic
Preservation Act and GS 121-12(a) has been completed for this project.
Brief description of review activities, results of review, and conclusions:
The initial review included an examination of topographic maps, the Surry County soil survey, an
aerial photograph, and information about previously recorded archaeological sites, previous
archaeological surveys, and environmental reviews at the North Carolina Office of State
Archaeology (OSA) in Raleigh. The A.P.E. includes land along both SR 1319 and SR 1318. SR
1319 at the bridge is oriented approximately east -west. SR 1319 curves to the north a short
distance west of the bridge. SR 1319 intersects with SR 1318 a short distance east of the bridge.
SR 1318 is oriented approximately north -south.
"NO NATIONAL REGISTER ELIGIBLE OR LISTED ARCHAEOLOGICAL SITES PRESENT OR AFFECTED
form for Minor Transportation Projects as Qualified in the 2015 Programmatic Agreement.
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Project Tracking No.
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The topographic maps (Roaring Gap and Thurmond) show the landforms in the A.P.E. include
ridge toes overlooking two streams (South Fork Mitchell River and unnamed tributary), and level
floodplain along both streams. Level ridge toes overlooking streams can have a moderate to high
potential for archaeological sites, depending upon the distance from and elevation above the
stream. Level, well -drained floodplains have a moderate to high potential for prehistoric
archaeological sites.
The aerial photograph shows the land use in the A.P.E. is a mix of wooded and cleared. The
cleared land appears to be agricultural fields or pasture. There are a couple of buildings in the
A.P.E. (farm buildings?). There appears to be an automobile junk yard on the east side of SR 1319
at the north end of the A.P.E.
The information at the OSA shows there are no previously recorded archaeological sites within or
adjacent to the A.P.E. The A.P.E. is not within any areas that have been previously surveyed for
archaeological sites. A project located along SR 1318 within the A.P.E. has been reviewed by the
State Historic Preservation Office (HPO) (ER 04-2801). The project was improvements to SR
1318, and no archaeological survey was recommended.
The review recommended survey of the level, well -drained landforms adjacent to streams within
the A.P.E. on 10/26/2018. A reconnaissance of the project was conducted on 10/29/2018. The
reconnaissance found that only one part of the A.P.E. included a landform with potential for
archaeological sites.
The northwest quadrant of the A.P.E. includes land along the north side of SR 1319 and the west
side of the tributary stream. The landform in the northwest quadrant is a sloped ridge. The western
part of the quadrant is a ridge top, and the eastern part is a slope down from the ridge to the tributary
stream. The land in this quadrant is currently used as a hay field or pasture. There are several
farm buildings located along SR 1319 on the ridge.
The northeast quadrant includes land along the west and east sides of SR 1318 to the north of the
SR 1319 intersection. The landform along the west side of SR 1318 is a narrow strip of land
between the road and the tributary. The land is sloped from the road down to the narrow floodplain
along the creek. The floodplain appears to be an unstable landform that is prone to flooding. The
landform along the east side of SR 1318 is a slope up to the east. Both sides of SR 1318 are
wooded.
The southeast quadrant includes the land along the west and east sides of SR 1318 south of the SR
1319 intersection. The landform along the west side of SR 1318 is a narrow strip between the road
and the tributary. The tributary joins the South Fork Mitchell River near the south end of the
A.P.E. The landform along the east side of SR 1318 is a slope uphill to the east. The land along
the east side of the road is a mix of wooded and hay field/pasture.
The southwest quadrant includes the land along the south side of SR 1319 west of the bridge. The
landform in the southwest quadrant is a sloped ridge along the south and west sides of SR 1319,
and a narrow strip of floodplain along the west side of the tributary, and the north and south sides
of the South Fork. The land along SR 1319 in the west half of the quadrant is a ridge top.
"NO NATIONAL REGISTER ELIGIBLE OR LISTED ARCHAEOLOGICAL SITES PRESENT OR AFFECTED
form for Minor Transportation Projects as Qualified in the 2015 Programmatic Agreement.
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Project Tracking No.
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The survey focused on the floodplain located along the west side of the tributary and the north side
of the South Fork. This land is currently used as a hay field or pasture. The narrow floodplain is
located at the base of a ridge that slopes up to the north. The floodplain on the south side of the
South Fork is wooded, indicating that it may be unsuitable for hay field or pasture (due to poor
drainage?). (The Surry County soil survey indicates that the soil on both sides of the river is
Colvard and Suches soils [0-3% slopes], occasionally flooded, a well -drained soil found on levees
in floodplains.)
The archaeological survey consisted of the excavation of three shovel tests (STs) along the west
side of the tributary and the north side of the South Fork. None of the STs contained any artifacts.
No STs were excavated on the south side of the South Fork. ST 1 was placed approximately 20
meters (66 ft.) south of the bridge and 10 meters (33 ft.) west of the tributary. The soil consisted
of 45 centimeters (18 in.) of brown silty loam and silty clay with a heavy gravel content. ST 2 was
placed approximately 30 meters (100 ft.) south of ST 1, 5 meters (16 ft.) west of the tributary, and
20 meters (66 ft.) north of the South Fork. The soil consisted of 65 centimeters (26 in.) of brown
silty clay loam with very little rock content. ST 3 was placed approximately 30 meters (100 ft.)
west of ST 2 and 10 meters (33 ft.) north of the South Fork. The soil consisted of 25 centimeters
(10 in.) of brown silty loam with a heavy gravel content. The floodplain to the west of ST 3 was
a very narrow strip because the ridge toe extends almost to the South Fork, so no more STs were
excavated.
In conclusion, the archaeological survey of the A.P.E. did not identify any archaeological sites.
Most of the land in the A.P.E. has a low potential for archaeological sites. No further work is
recommended for this project.
SUPPORT DOCUMENTATION
See attached: ® Map(s) ❑ Previous Survey Info
Other:
Signed:
CALEB SMITH
NCDOT ARCHAEOLOGIST
® Photos ❑Correspondence
5/3/2019
Date
"NO NATIONAL REGISTER ELIGIBLE OR LISTED ARCHAEOLOGICAL SITES PRESENT OR AFFECTED
form for Minor Transportation Projects as Qualified in the 2015 Programmatic Agreement.
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Project Tracking No.
18-09-0085
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4of11

Project Tracking No.
18-09-0085
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form for Minor Transportation Projects as Qualified in the 2015 Programmatic Agreement.
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Project Tracking No.
18-09-0085
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"NO NATIONAL REGISTER ELIGIBLE OR LISTED ARCHAEOLOGICAL SITES PRESENT OR AFFECTED
form for Minor Transportation Projects as Qualified in the 2015 Programmatic Agreement.
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Project Tracking No.
18-09-0085
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form for Minor Transportation Projects as Qualified in the 2015 Programmatic Agreement.
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Project Tracking No.
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form for Minor Transportation Projects as Quaked in the 2015 Programmatic Agreement.
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Project Tracking No.
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"NO NATIONAL REGISTER ELIGIBLE OR LISTED ARCHAEOLOGICAL SITES PRESENT OR AFFECTED
form for Minor Transportation Projects as Quaked in the 2015 Programmatic Agreement.
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Project Tracking No.
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form for Minor Transportation Projects as Quaked in the 2015 Programmatic Agreement.
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Project Tracking No.
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"NO NATIONAL REGISTER ELIGIBLE OR LISTED ARCHAEOLOGICAL SITES PRESENT OR AFFECTED
form for Minor Transportation Projects as Quaked in the 2015 Programmatic Agreement.
11 of 11

NC Department of Transportation Community Studies Group, Human Environment Section
Local Schools Input Form for
STIP Project BR-0123 COMMUNITY IMPACT ASSESSMENT
Contact Information
Interviewee Name: Rodney Hardy
Date: 2/15/2019
Title/Position: Director of Transportation
Phone Number: [phone]
Organization/Agency: Surry County Schools
Email: [e-mail]
Completed Via: ❑ Email ❑ Phone
Interview Information/Instructions
If completed by phone:
Interviewed By (Name/Organization):
If completed by email:
Using the project information and map below, please respond to the following questions by typing your answers in the
space provided. Then save (using the Save As command)
this file with a new file name for your records and e-mail the
new file back to the original sender. If you would prefer to complete a hard copy of this form, please send all sheets to
the following address or fax number:
Michelle Lopez
1600 Perimeter Park, Ste. 225
Morrisville, NC, 27560
Fax: [phone]
Project Information
„I► r ,
Replacement of Bridge No. 318 on SR 1319 (Abe
Mayes Road) over Unnamed Tributary of South
;G
Fork Mitchell River in Surry County, NCDOT
Division 11. Right of way acquisition is expected
in 2019, and construction is expected to begin in
2020.
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Check all questions that apply and provide a detailed explanation of your response in the
Check if item
I
field provided.
is applicable
1.
How many school buses [cross the bridge/pass through the corridor] per day (total # of daily
buses, total # daily of trips)?
a bus does not cross this bridge daily, it crosses maybe once a week
2.
Is the corridor used by carpool traffic or pedestrians to access local schools? If yes, please describe
the location and time(s) of day.
❑
3.
[Applicable if schools are located in or near the project area] Are there any Safe Routes to School
plans in place at schools in the vicinity of the project?
❑
4.
Based on your knowledge of the project area, do you have any concerns with the
condition/capacity of potential detour routes or the location of resources along these routes with
to school traffic?
El
S.
Are there any future time periods or events that you know of where bridge or road closure or
reduction in number of lanes for construction would be of particular concern?
❑
6.
Rate the overall impact on school transportation if the bridge or roadway were closed or at reduced capacity for
up to a year:
❑ No Impact ❑ Low Impact ❑ Moderate Impact ❑ High Impact
7.
Are road names referenced by the names locals would use?
❑
8.
Is there anyone else you feel should be contacted regarding this project (i.e. local officials or
stakeholders)?
❑
9.
Are there any other concerns you have regarding the potential impact of this project on school
transportation services or any additional comments? Please be as specific as possible.
❑

NC Department of Transportation Community Studies Group, Human Environment Section
Local Planner Input Form for
STIP Project BR-0123 COMMUNITY IMPACT ASSESSMENT
Contact Information
Interviewee Name: Kim Bates
Date: 03/26/2019
Title/Position: Planning Director
Phone Number: [phone]
Organization/Agency: Surry County Planning and Zoning
Email: [e-mail]
Completed Via: Email
Interview Information/Instructions
If completed by phone:
Interviewed By (Name/Organization):
If completed by email:
Using the project information and map below, please respond to the following questions by typing your answers in
the space provided. Then save (using the Save As command)
this file with a new file name for your records and e-
mail the new file back to the original sender. If you would prefer to complete a hard copy of this form, please send all
sheets to the address or fax number below:
Michelle Lopez
1600 Perimeter Park, Ste. 225
Morrisville, NC, 27560
Fax: [phone]
Project Information
jl
Replacement of Bridge No. 318 on SR 1319 (Abe
Mayes Road) over Unnamed Tributary of South
Y
1if
Fork Mitchell River in Surry County, NCDOT
Division 11. Right of way acquisition is expected
in 2019, and construction is expected to begin
in 2020.
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Check those questions that apply and provide a detailed explanation of your response I Check if item is
in the field provided. applicable
Growth and Development
1. Are there any known plans for development in the vicinity of the project?
❑
No
2. Are there any adopted plans for growth or economic development that could directly affect or
be affected by this project?
❑
No
3. Are there plans to extend water/sewer lines or to build any new facilities, such as fire stations,
schools, or other facilities, in the vicinity of the project? ❑
No
4. Are there any specific business and/or economic resources present in the project area, such as
business parks, distribution centers, manufacturing facilities, etc.? ❑
No
Special Populations
5. Are you aware of any minority, low-income or limited English proficiency (LEP) populations/
communities in the vicinity of the project? If so, please provide the locations of these
populations in the area. [If yes, proceed to Question 6. If no, skip to Question 7.]
No
6. Are there specific community resources or services that are used by minority, low-income or
LEP populations in the vicinity of the project? How is the project likely to affect minority and ❑
low-income populations?
No
7. Are there any tribal groups connected with land, religious, ethnic or other special populations
with different mobility needs or outreach needs in the project area?
No
8. Who should we contact to discuss outreach needs for any special populations? Please provide
input on community leader contacts, media sources or other ways to reach these populations. ❑
Surry County Dept of Social Services
Access, Accessibility, and Mobility
9. Is there pedestrian or bicycle activity/traffic or transit use along the project? If so, please
describe multimodal activity in the project area. ❑
No
10. Are there any existing access, accessibility, or mobility concerns or any barriers to non -auto
travel in the area? Please consider all modes.
❑
No
11. Are there any adopted plans for pedestrian, greenway, bicycle, or transit facilities in the area?
For each plan, please provide a description of how the plan applies to the project area, the
❑
title of the plan, its year of adoption, and the current status of its implementation.
No

Agricultural Operations
12. Are you aware of any active agricultural operations in the vicinity of the project? If so, please
describe these operations (e.g. size, ownership, crops, years farmed, suppliers, customers,
value to the community). [If yes, answer Question 12. If no, skip to Question 13.]
❑
Agricultural activities present and typical of all rural areas of the county
13. Are farm support services —such as farm suppliers, equipment dealers, processing and storage
facilities, and farmer's markets —located in the vicinity of the project? If so, please describe
these services (e.g. type, location).
❑
No
14. Does the project lie within a VAD or EVAD district, or are you aware of any land with other
farmland protections (plans, tax districts or credits, trust, agricultural zoning, deed
restrictions)? If so, please describe the nature and location of these areas and properties.
❑
No
Other Notable Features
15. Are there any recreational properties within the project area that were purchased or
improved with Land and Water Conservation Act funds?
❑
No
16. Are there any other specific notable community resources or issues in the project area? (e.g.
socio-economic resources, recreational resources, community safety concerns, cohesive
neighborhoods, areas in decline) If so, please describe.
❑
No
Detours and Closures
17. Are there any future time periods or events that you know of where road or bridge closure or
reduction in number of lanes for construction would be of particular concern?
❑
No
18. [If applicable] Based on your knowledge of the project area, do you have any concerns with
the condition/capacity of potential detour routes, or the location of resources along these
Elroutes?
No
19. Rate the overall impact on local planning objectives if the bridge or roadway were closed or at reduced capacity
for up to a year:
Moderate Impact
Closing Questions
20. Are road names referenced by the names locals would use?
❑
Yes
21. Is there anyone else you feel should be contacted regarding this project (i.e. local officials or
stakeholders)?
❑
No
22. Do you have any additional comments about this project?
❑
No

NATURAL RESOURCES TECHNICAL REPORT
Replacement of Bridge No. 850318 on SR 1319 (Abe Mayes Road) over
an Unnamed Tributary to South Fork Mitchell River
Surry County, North Carolina
STIP No. BR-0123
WBS Element No. 67123.3.1
THE NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
Environmental Coordination and Permitting
May 2019

TABLE OF CONTENTS
1.0 INTRODUCTION.......................................................................................................1
2.0 METHODOLOGY.....................................................................................................1
3.0 TERRESTRIAL COMMUNITIES...........................................................................1
4.0 PROTECTED SPECIES............................................................................................2
4.1 Endangered Species Act Protected Species.......................................................... 2
4.2 Bald and Golden Eagle Protection Act................................................................. 3
5.0 WATER RESOURCES..............................................................................................3
6.0 REGULATORY CONSIDERATIONS....................................................................4
6.1 Clean Water Act Waters of the U.S...................................................................... 4
6.2 Construction Moratoria......................................................................................... 5
6.3 N.C. River Basin Buffer Rules............................................................................... 5
6.4 Rivers and Harbors Act Section 10 Navigable Waters ....................................... 5
7.0 REFERENCES............................................................................................................6
Appendix A Figures
Figure 1. Vicinity Map
Figure 2. Project Study Area Map
Figure 3. Jurisdictional Features Map
Figure 4. Terrestrial Communities Map
Appendix B Qualifications of Contributors
Appendix C Protected Species Survey Reports
LIST OF TABLES
Table 1. Coverage of terrestrial communities in the study area...................................1
Table 2. ESA federally protected species listed for Surry County...............................2
Table 3. Potential streams in the study area...................................................................4
Table 4. Characteristics of potential jurisdictional streams in the study area ............ 4
Table 5. Characteristics of potential jurisdictional wetlands in the study area .......... 5

Natural Resources Technical Report STIP No. BR-0123, Surry County, N.C.
1.0 INTRODUCTION
The North Carolina Department of Transportation (NCDOT) proposes to replace Bridge
No. 850318 on SR 1319 (Abe Mayes Road) over an Unnamed Tributary (UT) to South
Fork Mitchell River in Surry County, North Carolina (STIP No. BR-0123; Figures 1-2).
The following Natural Resources Technical Report (NRTR) has been prepared to assist in
the preparation of a federally -funded Categorical Exclusion (CE), which will be prepared
in accordance with the National Environmental Policy Act (NEPA).
2.0 METHODOLOGY
All work was conducted in accordance with the NCDOT Environmental Coordination
and Permitting's (ECAP) Preparing Natural Resources Technical Reports Procedure and
the latest NRTR Template (November 2017). Field work was conducted on February 11,
2019. Potential jurisdictional areas identified in the study area have not been verified by
the United States Army Corps of Engineers (USACE) or the North Carolina Division of
Water Resources (NCDWR). It is anticipated that the USACE will cover the potential
features associated with this project under a Preliminary Jurisdictional Determination
(PJD). The principal personnel contributing to the field work and document are provided
in Appendix B.
3.0 TERRESTRIAL COMMUNITIES
Four terrestrial communities were identified in the study area. Figure 4 shows the
location and extent of these terrestrial communities. Terrestrial community data are
presented in the context of total coverage of each type within the study area (Table 1).
Table 1. Coverage of terrestrial communities in the study area
Community
Dominant Species (Scientific name)
Coverage
(ac.)
Fescue (Festuca spp.)
Maintained/Disturbed
Blackberry (Rubus argutus)
14.2
Japanese honeysuckle Lonicera 'a onica
Red maple (Acer rubrum)
Mixed Hardwood Forest
Chinese privet (Ligustrum sinense)
0.4
American holly Ilex o aca
Mixed Pine/Hardwood
Virginia pine (Pinus virginiana)
Forest
White pine (Pinus strobus)
1.3
American beech Fa us randi olia
Black cherry (Prunus serotina)
Floodplain Forest
Red maple (Acer rubrum)
0.7
Chinese privet Li ustrum sinense
Total
16.6
May 2019

Natural Resources Technical Report STIP No. BR-0123, Surry County, N.C.
4.0 PROTECTED SPECIES
4.1 Endangered Species Act Protected Species
As of June 27, 2018, the United States Fish and Wildlife (USFWS) lists four federally
protected species, under the Endangered Species Act (ESA), for Surry County (Table 2).
For each species, a discussion of the presence or absence of habitat is included below
along with the Biological Conclusion rendered based on survey results in the study area.
Table 2. ESA federally protected species listed for Surry County
Scientific Name
Common Name
Federal
Habitat
Biological
Status
Present
Conclusion
Glyptemys muhlenbergii
Bog turtle
T (S/A)
No
Not Required
Myotis septentrionalis
Northern long-eared bat
T
Yes
Meets 4(d)
rule
Helianthus schweinitzii
Schweinitz's sunflower
E
Yes
Unresolved
Isotria medeoloides*
Small whorled pogonia
T
Yes
Unresolved
E — Endangered; T — Threatened; T(S/A) - Threatened due to similarity of appearance
* - Historic record (the species was last observed in the county more than 50 years ago)
Bog turtle
USFWS Recommended Survey Window: April 1 — October 1 (visual surveys); April 1-
June 15 (optimal for breeding/nesting); May 1-June 30 (trapping surveys)
Biological Conclusion: Not Required
Species listed as threatened due to similarity of appearance do not require Section
7 consultation with the USFWS. Moreover, suitable habitat (open, spring -fed,
emergent wetlands) is not present within the study area. A review of the April
2019 North Carolina Natural Heritage Program (NCNHP) database showed one
known occurrence of this species within 1.0 mile of the study area (Element
Occurrence ID No. 11892).
Northern long-eared bat (NLEB)
USFWS Optimal Survey Window: June 1 — August 15
Biological Conclusion: Meets 4(d) rule
This species has been assessed by the NCDOT — Biological Surveys Group
(BSG). NCDOT has determined that the proposed action does not require
separate consultation on the grounds that the proposed action is consistent with
the final Section 4(d) rule, codified at 50 C.F.R. § 17.40(o) and effective February
16, 2016. NCDOT may presume its determination is informed by best available
information and consider Section 7 responsibilities fulfilled for NLEB.
2 May 2019

Natural Resources Technical Report STIP No. BR-0123, Surry County, N. C.
Schweinitz's sunflower
USFWS Optimal Survey Window: late August — October
Biological Conclusion: Unresolved
Suitable habitat for Schweinitz's sunflower is present within the study area.
Surveys for this species will be performed by Three Oaks staff in Fall 2019. A
review of the April 2019 NCNHP database showed no known occurrences of this
species within 1.0 mile of the study area.
Small whorled pogonia
USFWS Optimal Survey Window: mid -May -early July
Biological Conclusion: Unresolved
Suitable habitat for small whorled pogonia is present within the study area.
Surveys for this species will be performed by Three Oaks staff in mid -May 2019.
A review of the April 2019 NCNHP database showed no known occurrences of
this species within 1.0 mile of the study area.
4.2 Bald and Golden Eagle Protection Act
The bald eagle is protected under the Bald and Golden Eagle Protection Act and enforced
by the USFWS. Habitat for the bald eagle primarily consists of mature forests in
proximity to large bodies of open water for foraging. Large dominant trees are utilized
for nesting sites, typically within 1.0 mile of open water.
A desktop-GIS assessment of the study area, as well as the area within a 1.13-mile radius
of the project limits, was performed on February 8, 2019 using the most currently -
available orthoimagery. Water bodies large and sufficiently open enough to be
considered potential feeding sources were not identified. Since foraging habitat was not
present within the review area, a survey of the study area and the area within 660 feet of
the project limits was not required A review of the April 2019 NCNHP database
revealed no known occurrences of this species within 1.0 mile of the study area. Due to
lack of habitat, known occurrences, and minimal impact anticipated for this project, it has
been determined that this project will not affect this species.
5.0 WATER RESOURCES
The study area is part of the Yadkin — Pee Dee River Basin (U.S. Geological Survey
[USGS] Hydrologic Unit [HUC] 03040101). Three potential streams were identified in
the study area (Table 3). The locations of these streams are shown on Figures 3 and 4.
May 2019

Natural Resources Technical Report STIP No. BR-0123, Surry County, N.C.
Table 3. Potential streams in the study area
Bank
Bankfull
NCDWR Index
Best Usage
Depth
Stream Name
Map ID
Height
width
Number
Classification
(ft.)
(ft.)
(in.)
UT to South Fork
SA
12-62-13
C
0.5-3.5
2-3
1-3
Mitchell River
UT to South Fork
Mitchell River
SB
12-62-13
C
3-6
20-25
6-18
UT to South Fork
Mitchell River
SC
12-62-13
C
3-5
20-25
6-18
There are no Outstanding Resource Waters (ORW), High Quality Waters (HQW), or
water supply watersheds (WS-I or WS-II) within 1.0 mile downstream of the study area.
The project is within a USACE-designated trout watershed; however, the North Carolina
Wildlife Resources Commission (NCWRC) does not identify any trout waters within the
study area or within 1.0 mile downstream of the study area. The North Carolina 2016
Final 303(d) list of impaired waters identifies no impaired waters within the study area or
within 1.0 mile downstream of the study area.
No potential surface waters (i.e., ponds, tributaries, or basins) were identified within the
study area.
6.0 REGULATORY CONSIDERATIONS
6.1 Clean Water Act Waters of the U.S.
Three potential jurisdictional streams were identified in the study area (Table 4). The
locations of these streams are shown on Figures 3 and 4. A NCDWR stream
identification form and a North Carolina Stream Assessment Method (NCSAM) form for
Stream SA are included in a separate PJD Package. All potential jurisdictional streams in
the study area have been designated as cool water streams for the purposes of stream
mitigation.
Table 4. Characteristics of potential jurisdictional streams in the study area
Map
ID
Length
(ft.)
Classification
Compensatory Mitigation
Required
River Basin
Buffer
SA
21
Intermittent
Undetermined
Not Subject
SB
495
Perennial
Yes
Not Subject
SC
756
Perennial
Yes
Not Subject
Total
1,272
4 May 2019

Natural Resources Technical Report STIP No. BR-0123, Surry County, N.C.
One potential jurisdictional wetland was identified within the study area (Table 5). The
location of this wetland is shown on Figures 3 and 4. This wetland is located within the
Yadkin — Pee Dee River Basin (USGS HUC 03040101). USACE wetland determination
forms and a North Carolina Wetland Assessment Method (NCWAM) form for this
potential wetland are included in a separate PJD Package.
Table 5. Characteristics of potential jurisdictional wetlands in the study area
Map
NCWAM
Hydrologic
Area (ac.) in
NCWAM Classification
ID
Rating
Classification
Study Area
Non -tidal Freshwater
WA
Medium
Riparian
0.03
Marsh
Total
0.03
6.2 Construction Moratoria
The project is within a USACE-designated trout watershed; however, the NCWRC does
not identify any trout waters within or within 1.0 mile downstream of the study area. The
potential for trout -related in -water moratoria will be determined when comments from
USACE and NCWRC are received. No bat -related moratoria are anticipated for this
proj ect.
6.3 N.C. River Basin Buffer Rules
This project is located in the Yadkin — Pee Dee River Basin (USGS HUC 03040101).
Potential jurisdictional features within the study area are not subject to streamside
riparian zones protected under provisions administered by the North Carolina Department
of Environmental Quality (NCDEQ).
6.4 Rivers and Harbors Act Section 10 Navigable Waters
The USACE has not designated any waters in the study area as Navigable Waters under
Section 10 of the Rivers and Harbors Act.
5 May 2019

Natural Resources Technical Report
STIP No. BR-0123, Surry County, N.C.
7.0 REFERENCES
Environmental Laboratory. 1987. Corps of Engineers Wetlands Delineation Manual.
Technical Report Y-87-1, U. S. Army Engineer Waterways Experiment Station.
Vicksburg, Mississippi.
Environmental Laboratory. 1992. Clarification and Interpretation of the 1987 Manual,
memorandum from Major General Arthur E. Williams.
NatureServe. 2010. NatureServe Explorer: An online encyclopedia of life [web
application]. Version 7.1. NatureServe, Arlington, Virginia. Available
http://www.natureserve.org/explore .
North Carolina Department of Environment and Natural Resources (NCDENR) -
Division of Water Resources. 2018. Final 2016 North Carolina 303(d) List.
https:Hfiles.nc.gov/ncdeq/Water%20Quality/Planning/TMDL/303 d/2016/2016_N
C_Category_5_303d list.pdf.
North Carolina Natural Heritage Program. (NCNHP). 2001. Guide to Federally Listed
Endangered and Threatened Species of North Carolina. Raleigh, NC. 134 pp.
North Carolina Natural Heritage Program (NCNHP). 2018. Natural Heritage Data
Explorer [Web Application]. NCDNCR, Raleigh, NC.
http://ncnhde.natureserve.org. (Accessed: April 30, 2019).
North Carolina Stream Functional Assessment Team. North Carolina Stream Assessment
Method (NCSAM) User Manual [Version 2.1]. 2012. PDF Document.
North Carolina Wetland Functional Assessment Team. North Carolina Wetland
Assessment Method (NCWAM) User Manual [Version 5]. 2016. PDF
Document.
North Carolina Wildlife Resources Commission. (NCWRC) Bog Turtle Fact Sheet.
2018. https://www.ncwildlife.org/Leaming/Species/Reptiles/Bog Turtle.
Schafale, M.P. 2012. Guide to the Natural Communities of North Carolina: Fourth
Approximation. North Carolina Natural Heritage Program, North Carolina
Department of Environmental Quality (NCDEQ). Raleigh, North Carolina. 208
PP.
United States Army Corps of Engineers. 2012. Regional Supplement to the Corps of
Engineers Wetland Delineation Manual: Eastern Mountains and Piedmont Region
Version 2.0, ed. J. F. Berkowitz, J. S. Wakeley, R. W. Lichvar, C. V. Noble.
ERDC/EL TR-12-9. Vicksburg, MS: U.S. Army Engineer Research and
Development Center.
6 May 2019

Natural Resources Technical Report STIP No. BR-0123, Surry County, N. C.
United States Department of Agriculture (USDA), Natural Resources Conservation
Service (MRCS). 2007. Soil Survey of Surry County, North Carolina.
United States Department of Agriculture (USDA), Natural Resources Conservation
Service. 2018. Field Indicators of Hydric Soils in the United States, Version 8.2.
L.M. Vasilas, G.W. Hurt, and J.F. Berkowitz (eds.). USDA, NRCS, in
cooperation with the National Technical Committee for Hydric Soils.
United States Fish and Wildlife Service. (USFWS) 2018. Bog Turtle.
https://www.fws.gov/northeast/pyfo/es/bogturtle.
United States Fish and Wildlife Service. (USFWS) 2018. Information on Threatened and
Endangered Species: Small -whorled Pogonia.
https://www.fws.gov/midwest/endan eg red/plants/smallwhorledpogoniafs.html
United States Fish and Wildlife Service. (USFWS) 2016. Northern long-eared bat — what
it means for your project.
http://www.fws.gov/asheville/htmis/project review/NLEB_in WNC.html.
United States Fish and Wildlife Service (USFWS) 2017. Northern long-eared bat — what
it means for your project. https://www.fws.gov/raleigh/NLEB_RFO.html.
United States Fish and Wildlife Service. (USFWS) Northern long-eared bat (Myotis
septentrionalis). https://ecos.fws. og v/ecp0/profile/speciesProfile?spcode=AOJE.
United States Fish and Wildlife Service. (USFWS) 2006. Optimal Survey Windows for
North Carolina's Federally Threatened and Endangered Plant Species.
http://www.fws.gov/nc-es/es/plant survey.html.
United States Fish and Wildlife Service. (USFWS) 1994. Schweinitz's Sunflower
Recovery Plan. Atlanta, GA. 28 pp.
United States Fish and Wildlife Service. (USFWS) Schweinitz's Sunflower (Helianthus
schweinitzii). https://www.fws.gov/raleigh/sspecies/es_schweinitz_sunflower.html
(Accessed: December 20, 2018).
United States Fish and Wildlife Service. (USFWS) 1992. Small Whorled Pogonia
(Isotria medeoloides) Recovery Plan, First Revision. Newton Corner,
Massachusetts. 75 pp.
United States Fish and Wildlife Service (USFWS). Threatened and Endangered Species
in North Carolina: Surry County. Updated June 27, 2018.
https://www.fws.gov/raleigh/species/cntylist/suny.html
7 May 2019

Natural Resources Technical Report STIP No. BR-0123, Surry County, N. C.
United States Geological Survey (USGS). 2016. Roaring Gap, North Carolina,
Topographic Quadrangle (7.5-minute series).
United States Geological Survey (USGS). 2016. Thurmond, North Carolina, Topographic
Quadrangle (7.5-minute series).
Weakley, Alan S. (Working Draft of May 21, 2015). Flora of the Southern and Mid -
Atlantic States. University of North Carolina Herbarium (NCU), North Carolina
Botanical Garden. Chapel Hill, NC. 1,320 pp.
8 May 2019

Appendix A
Figures

\uEER ? j
Prepared For:
UAi
b 9'
}
A pq
QF gA
Replacement of Bridge No. 318
on SR 1319 (Abe Mayes Rd.)
over UT of South Fork Mitchell River
STIP No. BR-0123
Project Vicinity Map
Surry County, North Carolina
Date:
APRIL 2019
Scale:
0 200 400 Feet
I I i
Job No.:
18-025
rawn y:
lChecked By
CMR
I JSM
Figure

NO,
Legend
= Project Study Area
Prepared For:
lIOAi
a
r ¢
1�p
CO
W,
0
USGS The National Map: National Boundaries Dataset, 3DEP
Elevation Program, Geographic Names Information System National
Hydrography Dataset, National Land Cover Database ationaI
Structures-D` set, and National Trans-port_ation-Dataset; USGS Global
Ecosystems; U-S-C-ensus-Bureau TIGER /Line data; USFS Road Data;
Natural Earth Data; U.S. Department of State Humanitarian Information
Unit; and NOAA National Centers for Environmental Information, U.S.
Coastal Relief Model. Data refreshed October 2018.
Replacement of Bridge No. 318
on SR 1319 (Abe Mayes Rd.)
over UT of South Fork Mitchell River
STIP No. BR-0123
Topographic Map
Surry County, North Carolina
Date:
APRIL 2019
Scale:
0 200 400 Feet
i I J
Job No.:
18-025
rawn y:
lChecked By
CMR I
JSM
Figure

Prepared For:
VRI$
4, of
OF I'S"
4�
Replacement of Bridge No. 318
on SR 1319 (Abe Mayes Rd.)
over UT of South Fork Mitchell River
STIP No. BR-0123
Jurisdictional Features Map
Surry County, North Carolina
Date.
APRIL 2019
Scale:
0 100 200 Feet
I i I
Job No.:
18-025
rawn y:
IChecked By
CMR
I JSM
Figure

Prepared For. -
OF IA"
Replacement of Bridge No. 318
on SR 1319 (Abe Mayes Rd.)
over UT of South Fork Mitchell River
STIP No. BR-0123
Terrestrial Communities Map
Surry County, North Carolina
Date.
APRIL 2019
Scale:
0 100 200 Feet
I i I
Job No.:
18-025
rawn y:
IChecked By
CMR
I JSM
Figure

Appendix B
Qualifications of Contributors
Investigator James Mason
Education: B.A. Biology, Colby College, 2000
M.S. Biology/Ecology, UNC-Charlotte, 2004
Experience: Environmental Senior Scientist, Three Oaks Engineering, April
2018-Present
Environmental Program Consultant, NCDOT, 2006-2018
Responsibilities: Wetland and stream assessment, T&E surveys, document
preparation/review
Investigator: Lillian Lovingood
Education: B.S. Environmental Studies: Ecology and Environmental Biology,
UNC-Asheville, 2016
Experience: Environmental Scientist, Three Oaks Engineering, December
2018-Present
Aquatic Conservation Technician, NCWRC, March 2018-
November 2018
Responsibilities: Wetland and stream assessment, T&E surveys, document review
Investigator: Hayley Wood
Education: B.S. Earth Sciences, UNC-Charlotte, 2017
Experience: Environmental Scientist, Three Oaks Engineering, October 2018-
Present
Environmental Scientist, WK Dickson, June 2018-September 2018
Responsibilities: Document review
Investigator: Cary Rowells
Education: Coursework, Civil Engineering, Wake technical Community
College
Coursework, Geology, University of North Carolina at Wilmington
Experience: GIS Analyst, Three Oaks Engineering, 2015-Present
GIS analyst, Michael Baker Engineering, 2002-2015
Analytical Surveys, Inc., CADD Technician/GIS Technician/GIS
Project Coordinator, 1989-2002
Responsibilities: GIS Mapping, Microstation

Appendix C
Protected Species Survey Reports

,;j�5SA7_F
a wPm
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER
GOVERNOR
February 7, 2019
Dear Landowner:
JAMES H. TROGDON, III
SECRETARY
The N.C. Department of Transportation (Department) is constantly working to provide -better and
safer transportation facilities for public uses in North Carolina. The effects that these proposed
facilities have on the human and natural environment are of great concern to the Department and
must be adequately described in environmental documents. As part of this process, the Department
is obligated to identify and document environmental resources so that they can be avoided or impacts
reduced. Streams and wetlands are two of the resources that must be identified during the review
process. The Department has begun planning studies for the proposed replacement of Bridge No. 318
on Abe Mayes Road (S.R. 1319) over an unnamed tributary to South Fork Mitchell River as TIP
Project BR-0123.
Over the next several months, representatives of the Department including engineers, surveyors,
geologists, and biologists as well as the U.S. Army Corps of Engineers, Wilmington District,
Regulatory Division, may be present on your property. They will be collecting data that will be used
to design the project and conducting or verifying the limits of streams and wetlands pursuant to
Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. These
representatives will be wearing highly reflective safety vests, have picture ID badges, and will be
hanging various colors of flagging, or ribbons, on trees and shrubs to identify the limits of streams
and wetlands, if present, on the property. This flagging does not indicate the final location of a
proposed transportation project, but it is very important in our environmental review process. Please
do not disturb this flagging.
Please note that if the U.S. Army Corps of Engineers has already issued a Jurisdictional
Determination on your property confirming the presence of streams and/or wetlands, or if you have
general questions or comments about the project, contact David Stutts at [e-mail] or (919)
707-6442.
If you call, please mention NCDOT project number BR-0123.
Thank you for your cooperation.
Sincerely,
Cam& Z:),ae32r,"
�2 Philip S. Harris III, P.E., C.P.M.
(� Environmental Analysis Unit Head
Mailing Address:
NC DEPARTMENT OF TRANSPORTATION
ENVIRONMENTAL ANALYSIS UNIT
1598 MAIL SERVICE CENTER
RALEIGH NC 27699-1598
Telephone: [phone]
Customer Service: 1-877-368-4968
Website: www.ncdot.gov
Physical Address:
1000 BIRCH RIDGE DRIVE
NCDOT CENTURY CENTER
BUILDING A
RALEIGH NC 27610

�w ySAT(
I if
ESTADO DE CAROLINA DEL NORTE
DEPARTMENTO DE TRANSPORTE
Roy COOPER
GOBERNADOR
7 de Febrero de 2019
Estimado propietario:
JAMES H. TROGDON, III
SECRETARIO
El Departamento de Transporte de Carolina del Norte (Departamento) trabaja constantemente para
ofrecer mejores y mas seguras instalaciones de transporte para el use pAblico en Carolina del Norte.
Los efectos que estas instalaciones propuestas tienen sobre el medio ambiente representan una gran
preocupaci6npara el Departamento y deben ser descritas adecuadamente en documentos ambientales.
Como parte de este proceso, el Departamento esta obligado a identificar y documentar recursos
ambientales con el fin de evitar o reducir los impactos. Los arroyos y los humedales son dos de los
recursos que deben ser identificados durante el proceso de revisi6n. El Departamento ha comenzado
los estudios de planeaci6n relacionados con su propuesta de Puente No. 318 en Abe Mayes Road
(S.R. 1319) sobre un afluente sin nombre a South Fork Mitchell River identificado como Proyecto
TIP BR-0123.
Durante los pr6ximos meses, es posible que representantes del Departamento, asi como del Cuerpo
de Ingenieros del Ej6rcito de los Estados Unidos del Distrito de Wilmington, pertenecientes a la
Divisi6n Regulatoria, se presenten en su propiedad con el prop6sito de conducir o verificar los limites
de cuerpos de agua y humedales de conformidad con la Secci6n 404 del Acta de Agua Limpia y/o la
Secci6n 10 del Acta de Rios y Puertos de 1899. Estos representantes vestiran chalecos de seguridad
altamente brillantes, llevaran credenciales de identificaci6n con fotografia y estaran colgando
banderines o listones de varios colores en arboles y arbustos para identificar los limites de arroyos y
humedales que existan en la propiedad. Este mapeo no significa que en la zona se contemple un
posible proyecto de transporte, pero es muy importante en nuestro proceso de analisis ambiental. Por
favor no retire dichos banderines o listones.
Por favor tome en cuenta que si el Cuerpo de Ingenieros del Ej6rcito de los EE.UU. ha emitido una
Determinaci6n Jurisdiccional en su propiedad confirmando la presencia de arroyos y/o humedales, o
si tiene preguntas o comentarios relacionados con el proyecto, por favor llame a la Linea Directa en
Espanol del NCDOT al 1-800-481-6494 o contacte al gerente del proyecto del NCDOT David Stuffs
at [e-mail] or [phone].
Cuando llame, por favor mencione el Proyecto TIP BR-0123 del NCDOT.
Gracias por su cooperaci6n.
Atentamente,
UU
�2 Philip S. Harris
III, P.E., C.P.M.
Titular de la Unidad de Analisis Ambiental
Direccion de correo:
NC DEPARTMENT OF TRANSPORTATION
ENVIRONMENTAL ANALYSIS UNIT
1598 MAIL SERVICE CENTER
RALEIGH NC 27699-1598
Telefono: [phone]
Servicio a clientes: 1-877-368-4968
Sitio web: www.ncdot.gov
Direccion fascia:
1000 BIRCH RIDGE ROAD
NCDOT CENTURY CENTER
BUILDING A
RALEIGH NC 27610

bcc: Division Engineer
Jamille Robbins
Division ROW Agent
County Sheriff / City Police (if in municipality)
USACE Representative
Primary Project Contact (from letter)
L&S Area Locating Engineer
File

Roy COOPER
GOVERNOR
WO
FROM
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
JAMES H. TROGDON, III
SECRETARY
March 25, 2019
Heaven Manning
Environmental Coordination & Permitting Group Western, EAU
Melissa Miller, Environmental Program Consultant
Biological Surveys Group, EAU
SUBJECT: Section 7 survey results for the northern long-eared bat (Myotis
septentrionalis) associated with the replacement of Bridge No. 318 over UT
of S. Fork Mitchell River on SR 1319 in Surry County, TIP No. BR-0123.
The North Carolina Department of Transportation (NCDOT, Division 11) proposes to
replace Bridge No. 318 over UT of S. Fork of Mitchell River on SR 1319 in Surry County, TIP
No. BR-0123. The existing bridge is a single span structure with steel beams, and timber
deck, concrete end walls and timber guard rails. The overall length of the structure is 26
feet.
Northern long-eared bat
The project to replace Bridge No. 318 has been reviewed for effects on the northern long-
eared bat (NLEB). As of May 4, 2015, NLEB is listed by the U.S. Fish and Wildlife Service
(USFWS) as "Threatened" under the Endangered Species Act of 1973. As of March 25, 2019,
NLEB is listed by USFWS (http://www.fws.gov/raleigh/speciesIcntylist/nc counties.html)
as "probable/potential" in Surry County. USFWS also established a final rule under the
authority of section 4(d) of the Endangered Species Act that provides measures for the
conservation of NLEB. The USFWS has tailored the final 4(d) rule to prohibit the take of
NLEB from certain activities within areas where they are in decline. This incidental take
protection applies only to known NLEB occupied maternity roost trees and known NLEB
hibernacula. Effective February 16, 2016, incidental take resulting from tree removal is
prohibited if it 1) occurs within a 1/a. mile radius of known NLEB hibernacula; or 2) cuts or
destroys known occupied maternity roost trees or any other trees within a 150-foot radius
from the known maternity tree during the pup season (June 1-July 31).
Mailing Address:
NC DEPARTMENT OF TRANSPORTATION
PROJECT DEVELOPMENT &
ENVIRONMENTAL ANALYSIS UNIT
1598 MAIL SERVICE CENTER
RALEIGH NC 27699-1598
TELEPHONE: [phone]
FAX: [phone]
WEBSITE:NCDOT.GOV
Location:
CENTURY CENTER, BUILDING A
1020 BIRCH RIDGE DRIVE
RALEIGH NC 27610

According to the North Carolina Natural Heritage Program (NHP) Biotics Database, most
recently updated January 2019, the nearest NLEB hibernacula record is 55 miles west of
the project and no known NLEB roost trees occur within 150 feet of the project area.
NCDOT has also reviewed the USFWS Asheville Field office website
(http://www.fws.gov/asheville/htmis/project review/NLEB in WNC.html) for consistency
with NHP records. This project is located entirely outside of the red highlighted areas (12-
digit HUC) that the USFWS Asheville Field Office has determined to be representative of an
area that may require consultation.
For the proposed action, NCDOT has committed to the conservation measures listed below:
1) No alterations of a known hibernacula entrance or interior environment if it impairs
an essential behavioral pattern, including sheltering northern long-eared bats
(January 1 through December 31);
2) No tree removal within a 0.25 mile radius of a known hibernacula (January 1
through December 31); and
3) No cutting or destroying a known, occupied maternity roost tree, or any other trees
within a 150-foot radius from the known, occupied maternity tree during the period
from June 1 through and including July 31.
NCDOT has determined that the proposed action does not require separate
consultation on the grounds that the proposed action is consistent with the final
Section 4(d) rule, codified at 50 C.F.R. § 17.40(o) and effective February 16, 2016. NCDOT
may presume its determination is informed by best available information and consider
Section 7 responsibilities fulfilled for NLEB.
If you need any additional information, please contact Melissa Miller at 919-707-6127.

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER
GOVERNOR
May 22, 2019
U.S. Army Corps of Engineers
ATTN: Steven Kichefski
Asheville Regulatory Field Office
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
JAMES H. TROGDON, III
SECRETARY
SUBJECT: Preliminary Jurisdictional Determination Package for the following Natural
Resources Technical Report: STIP No. BR-0123: Replace Bridge No. 850318 on SR
1319 (Abe Mayes Road) over an Unnamed Tributary to South Fork Mitchell River in
Surry County, North Carolina.
Mr. Kichefski,
The North Carolina Department of Transportation (NCDOT) proposes the replacement of Bridge No.
850318 on SR 1319 (Abe Mayes Road) over an Unnamed Tributary (UT) to South Fork Mitchell River
in Surry County, North Carolina. Below and attached are a brief description of the project, figures
depicting all features, and appropriate forms.
Field work was conducted on February 11, 2019. Three Oaks Engineering (Three Oaks) staff members
Jim Mason and Lillian Lovingood conducted the site investigation (Figure 1). Four potential
jurisdictional features (three streams and one wetland) were identified within the study area (Tables 1-3;
Figures 2-3). No potential jurisdictional surface waters (i.e. ponds, basins, or tributaries) were
identified.
A North Carolina Division of Water Resources (NCDWR) Stream Identification form and a North
Carolina Stream Assessment Method (NCSAM) form are included for Stream SA. United States Army
Corps of Engineers (USACE) wetland determination forms and a North Carolina Wetland Assessment
Method (NCWAM) form are included for Wetland WA. Please see the following PJD Package:
Mailing Address:
NC DEPARTMENT OF TRANSPORTATION
ENVIRONMENTAL COORDINATION AND
PERMITTING
1598 MAIL SERVICE CENTER
RALEIGH, NC 27699-1598
Telephone: [phone]
Customer Service: 1-877-368-4968
Website: www.ncdot.gov
Location:
CENTURY CENTER, BUILDING A
1000 BIRCH RIDGE DRIVE
RALEIGH, NC 27610

Table 1. Potential .jurisdictional streams in the study area
Stream Name
Map ID
NCDWR Index
Number
Best Usage
Classification
UT to South Fork Mitchell River
SA
12-62-13
C
UT to South Fork Mitchell River
SB
12-62-13
C
UT to South Fork Mitchell River
SC
12-62-13
C
Table 2. Characteristics of potential jurisdictional streams in the study area
Map ID
Length
(ft.)
Classification
NCSAM Rating
Compensatory
Mitigation Required
River Basin Buffer
SA
21
Intermittent
Medium/Medium
Undetermined
Not Subject
SB
495
Perennial
*
Yes
Not Subject
SC
756
Perennial
*
Yes
Not Subject
Total
1,272
Note: NCSAM forms were not completed for Streams SB and SC due to a lack of degraded conditions that would potentially
result in reduced mitigation ratios.
Table 3. Characteristics of potential _jurisdictional wetlands in the study area
NCWAM
Hydrologic
Map ID
NCWAM Classification
Area (ac.)
Rating
Classification
WA
Non -tidal Freshwater Marsh
Medium
Riparian
0.03
Total
0.03
If you have any questions, require additional information, or would like to schedule a site visit, please
contact me at [phone] or by email at [e-mail]. This is a request for concurrence
with our assessment. We appreciate your assistance on this project.
Sincerely,
Ron Johnson
North Carolina Department of Transportation
Environmental Analysis Unit
Cc: Dave Wanucha, NCDWR

Appendix A
Figures

\uEER ? j
Prepared For:
UAi
b 9'
}
A pq
QF gA
Replacement of Bridge No. 318
on SR 1319 (Abe Mayes Rd.)
over UT of South Fork Mitchell River
STIP No. BR-0123
Project Vicinity Map
Surry County, North Carolina
Date:
APRIL 2019
Scale:
0 200 400 Feet
I I i
Job No.:
18-025
rawn y:
lChecked By
CMR
I JSM
Figure

B
2�1.
rA
Legend
Potential Non -Wetland Waters of the U.S. (Stream) USGS The National Map National Boundaries Dataset, 3DEP
Intermittent Elevation Program, Geog phic Names Information System, National
Hydrography Dataset; National Land Cover Database, National
Perennial Structures Dataset„and.National Transportation Dataset; USGS Global
Potential Wetland Waters of the U.S. Ecosystems; U.S. Census Bureau TIGER/Line data; USFS Road Data;
Natural Earth Data; U.S. Department of State Humanitarian Information
Project Study Area Unit, and NOAA National Centers for Environmental Information, U.S.
Coastal Relief Model. Data refreshed October 2018.
Prepared For:
0R
M
o�=
4
�Yp OF }RR�
Replacement of Bridge No. 318
on SR 1319 (Abe Mayes Rd.)
over UT of South Fork Mitchell River
STIP No. BR-0123
Topographic Map
Surry County, North Carolina
Date:
APRIL 2019
Scale:
0 100 200 Feet
I I
Job No.:
18-025
rawn y:
Checked By
I
JSM
Figure

Prepared For:
VRI$
4, of
OF I'S"
4�
Replacement of Bridge No. 318
on SR 1319 (Abe Mayes Rd.)
over UT of South Fork Mitchell River
STIP No. BR-0123
Jurisdictional Features Map
Surry County, North Carolina
Date.
APRIL 2019
Scale:
0 100 200 Feet
I i I
Job No.:
18-025
rawn y:
IChecked By
CMR
I JSM
Figure

Appendix B
Stream and Wetland Data Forms

NC DWQ Stream Identification Form Version 4.11
Date:2/11/2019
Project/Site: BR-0123/SA
Latitude:36.37377
Evaluator: J. Mason, L. Lovingood-Three Oaks Eng.
County: Surry
Longitude:-80.876611
Total Points:
Stream is at least intermittent 22.0
Stream Determ' circle one)
Other
if >_ 19 or perennial if >_ 30
Ephemeral ntermittent erennial
e.g. Quad Name:
A. Geomorphology (Subtotal = 9.0 )
Absent
Weak
ModArate
Strong
1 a. Continuity of channel bed and bank
0
1
2
3
2. Sinuosity of channel along thalweg
0
1
(2)3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0
1
2
3
4. Particle size of stream substrate
0
1
2
3
5. Active/relict floodplain
0
2
3
6. Depositional bars or benches
0
2
3
7. Recent alluvial deposits
0
2
3
8. Headcuts
1
2
3
9. Grade control
0
1
1.5
10. Natural valley
0
0.5
1
1.5
11. Second or greater order channel
No = 0
Yes = 3
artificial ditches are not rated; see discussions in manual
B. Hydrology (Subtotal = 6.5 )
12. Presence of Baseflow
0
1
2
3
13. Iron oxidizing bacteria
0
11.2
3
14. Leaf litter
1
0.5
0
15. Sediment on plants or debris
0
0 5
1
1.5
16. Organic debris lines or piles
0
U.
1
1.5
17. Soil -based evidence of high water table?
No = 0
Yes = 3
C. Biology (Subtotal = 6.5
18. Fibrous roots in streambed
3
2
1
0
19. Rooted upland plants in streambed
2
1
0
20. Macrobenthos (note diversity and abundance)
1
2
3
21. Aquatic Mollusks
0
1
2
3
22. Fish
0
0.5
1
1.5
23. Crayfish
0
0.5
1
1.5
24. Amphibians
0
0.5
1
1.5
25. Algae
0
0.5
1
1.5
26. Wetland plants in streambed
FAC = 0.75; OBL = 1.5 Othe = 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
Sketch:

Accompanies user manual version z.i
USACE AID #: NCDWR #:
INSTRUCTIONS: Attach a sketch of the assessment area and photographs. Attach a copy of the USGS 7.5-minute topographic
quadrangle, and circle the location of the stream reach under evaluation. If multiple stream reaches will be evaluated on the same
property, identify and number all reaches on the attached map, and include a separate form for each reach. See the NC SAM User
Manual for detailed descriptions and explanations of requested information. Record in the "Notes/Sketch" section if any supplementary
measurements were performed. See the NC SAM User Manual for examples of additional measurements that may be relevant.
NOTE EVIDENCE OF STRESSORS AFFECTING THE ASSESSMENT AREA (do not need to be within the assessment area).
PROJECT / SITE INFORMATION:
1. Project name (if any): BR-0123 2. Date of evaluation: 2/11/2019
3. Applicant/owner name: NCDOT 4. Assessor name/organization: J. Mason/L. Lovingood - Three Oaks
5. County: Surry 6. Nearest named water body
7. River Basin: Yadkin-PeeDee on USGS 7.5-minute quad: South Fork Mitchell River
8. Site coordinates (decimal degrees, at lower end of assessment reach): 36.37377,-80.876611
STREAM INFORMATION: (depth and width can be approximations)
9. Site number (show on attached map): SA 10. Length of assessment reach evaluated (feet): 50
11. Channel depth from bed (in riffle, if present) to top of bank (feet): 0.5-3.5 F Unable to assess channel depth.
12. Channel width at top of bank (feet): 2-3 13. Is assessment reach a swamp stream? C" Yes r~ No
14. Feature type: r Perennial flow r: Intermittent flow Tidal Marsh Stream
STREAM RATING INFORMATION:
15. NC SAM Zone: C' Mountains (M) C: Piedmont (P) C Inner Coastal Plain (1) C' Outer Coastal Plain (0)
16. Estimated geomorphic l 1
valley shape (skip for (: a �`�- C' b
Tidal Marsh Stream): (more sinuous stream, flatter valley slope) (less sinuous stream, steeper valley slope)
17. Watershed size: (skip C: Size 1 (< 0.1 mi2) C Size 2 (0.1 to < 0.5 mil) C' Size 3 (0.5 to < 5 mil) C' Size 4 (>: 5 mil)
for Tidal Marsh Stream)
ADDITIONAL INFORMATION:
18. Were regulatory considerations evaluated? r: Yes C' No If Yes, check all that appy to the assessment area.
F Section 10 water FIClassified Trout Waters F Water Supply Watershed ( (` I r II r III r IV r V)
F Essential Fish Habitat F Primary Nursery Area F High Quality Waters/Outstanding Resource Waters
F Publicly owned property F NCDWR riparian buffer rule in effect F Nutrient Sensitive Waters
F Anadromous fish F 303(d) List F CAMA Area of Environmental Concern (AEC)
F Documented presence of a federal and/or state listed protected species within the assessment area.
List species:
F Designated Critical Habitat (list species):
19. Are additional stream information/supplementary measurements included in "Notes/Sketch" section or attached? r' Yes r: No
1. Channel Water - assessment reach metric (skip for Size 1 streams and Tidal Marsh Streams)
A Water throughout assessment reach.
B No flow, water in pools only.
C No water in assessment reach.
2. Evidence of Flow Restriction - assessment reach metric
C' A At least 10% of assessment reach in -stream habitat or riffle -pool sequence is adversely affected by a flow restriction or fill to the
point of obstructing flow or a channel choked with aquatic macrophytes or ponded water or impounded on flood or ebb within
the assessment reach (examples: undersized or perched culverts, causeways that constrict the channel, tidal gates).
r: B Not A
3. Feature Pattern - assessment reach metric
C' A A majority of the assessment reach has altered pattern (examples: straightening, modification above or below culvert).
C: B Not A.
4. Feature Longitudinal Profile - assessment reach metric
r: A Majority of assessment reach has a substantially altered stream profile (examples: channel down -cutting, existing damming,
over widening, active aggradation, dredging, and excavation where appropriate channel profile has not reformed from any of
these disturbances).
C' B Not A
5. Signs of Active Instability - assessment reach metric
Consider only current instability, not past events from which the stream has currently recovered. Examples of instability include
active bank failure, active channel down -cutting (head -cut), active widening, and artificial hardening (such as concrete, gabion, rip -rap).
C` A < 10% of channel unstable
r: B 10 to 25% of channel unstable
C' C > 25% of channel unstable
6. Streamside Area Interaction - streamside area metric
Consider for the Left Bank (LB) and the Right Bank (RB).
LB RB
A r' A Little or no evidence of conditions that adversely affect reference interaction
r: B r: B Moderate evidence of conditions (examples: berms, levees, down -cutting, aggradation, dredging) that adversely affect
reference interaction (examples: limited streamside area access, disruption of flood flows through streamside area,
leaky or intermittent bulkheads, causeways with floodplain constriction, minor ditching [including mosquito ditching])
C' C C' C Extensive evidence of conditions that adversely affect reference interaction (little to no floodplain/intertidal zone access
[examples: causeways with floodplain and channel constriction, bulkheads, retaining walls, fill, stream incision,
disruption of flood flows through streamside area] or too much floodplain/intertidal zone access [examples:
impoundments, intensive mosquito ditching]) or floodplain/intertidal zone unnaturally absent or assessment reach is a
man-made feature on an interstream divide
7. Water Quality Stressors - assessment reach/intertidal zone metric
Check all that apply.
F A Discolored water in stream or intertidal zone (milky white, blue, unnatural water discoloration, oil sheen, stream foam)
F B Excessive sedimentation (burying of stream features or intertidal zone)

F C Noticeable evidence of pollutant discharges entering the assessment reach and causing a water quality problem
F D Odor (not including natural sulfide odors)
F E Current published or collected data indicating degraded water quality in the assessment reach. Cite source in the "Notes/Sketch"
section.
FIF Livestock with access to stream or intertidal zone
F G Excessive algae in stream or intertidal zone
F H Degraded marsh vegetation in the intertidal zone (removal, burning, regular mowing, destruction, etc.)
F I Other: (explain in "Notes/Sketch" section)
F J Little to no stressors
8. Recent Weather — watershed metric
For Size 1 or 2 streams, D1 drought or higher is considered a drought; for Size 3 or 4 streams, D2 drought or higher is considered a
drought.
(' A Drought conditions and no rainfall or rainfall not exceeding 1 inch within the last 48 hours
(` B Drought conditions and rainfall exceeding 1 inch within the last 48 hours
(? C No drought conditions
9 Large or Dangerous Stream — assessment reach metric
(' Yes (: No Is stream is too large or dangerous to assess? If Yes, skip to Metric 13 (Streamside Area Ground Surface Condition).
10. Natural In -stream Habitat Types —assessment reach metric
10a. r Yes r No Degraded in -stream habitat over majority of the assessment reach (examples of stressors include excessive
sedimentation, mining, excavation, in -stream hardening [for example, rip -rap], recent dredging, and snagging)
(evaluate for size 4 Coastal Plain streams only, then skip to Metric 12)
10b. Check all that occur (occurs if > 5% coverage of assessment reach) (skip for Size 4 Coastal Plain streams)
F A
Multiple aquatic macrophytes and aquatic mosses
� E
F F
5% oysters or other natural hard bottoms
(include liverworts, lichens, and algal mats)
P m
F G
Submerged aquatic vegetation
F B
Multiple sticks and/or leaf packs and/or emergent
m
o 2,
F H
Low -tide refugia (pools)
vegetation
o y o
F I
Sand bottom
C
Multiple snags and logs (including lap trees)
t m
F J
5% vertical bank along the marsh
F D
5% undercut banks and/or root mats and/or roots
U
F K
Little or no habitat
in banks extend to the normal wetted perimeter
FOIE
Little or no habitat
*********************************REMAINING QUESTIONS ARE NOT APPLICABLE FOR TIDAL MARSH STREAMS****************************
11. Bedform and Substrate —assessment reach metric (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
11 a. (` Yes (: No Is assessment reach in a natural sand -bed stream? (skip for Coastal Plain streams)
11 b. Bedform evaluated. Check the appropriate box(es).
FIA Riffle -run section (evaluate 11c)
F B Pool -glide section (evaluate 11d)
F C Natural bedform absent (skip to Metric 12, Aquatic Life)
11 c. In riffles sections, check all that occur below the normal wetted perimeter of the assessment reach — whether or not submerged.
Check at least one box in each row (skip for Size 4 Coastal Plain Streams and Tidal Marsh Streams). Not Present (NP) _
absent, Rare (R) = present but <_ 10%, Common (C) _ > 10-40%, Abundant (A) _ > 40-70%, Predominant (P) _ > 70%. Cumulative
percentages should not exceed 100% for each assessment reach.
NP R C A P
Bedrock/saprolite
Boulder (256 — 4096 mm)
Cobble (64 — 256 mm)
Gravel (2 — 64 mm)
Sand (.062 — 2 mm)
Silt/clay (< 0.062 mm)
Detritus
Artificial (rip -rap, concrete, etc.)
11d. (' Yes (' No Are pools filled with sediment? (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)

12. Aquatic Life — assessment reach metric (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
12a. Ca Yes C' No Was an in -stream aquatic life assessment performed as described in the User Manual?
If No, select one of the following reasons and skip to Metric 13. C' No Water C' Other:
12b. r Yes (a No Are aquatic organisms present in the assessment reach (look in riffles, pools, then snags)? If Yes, check
all that apply. If No, skip to Metric 13.
1 >1 Numbers over columns refer to "individuals" for size 1 and 2 streams and "taxa" for size 3 and 4 streams.
F F Adult frogs
F FAquatic reptiles
F FAquatic macrophytes and aquatic mosses (include liverworts, lichens, and algal mats)
F F Beetles (including water pennies)
F F Caddisfly larvae (Trichoptera [T])
F F Asian clam (Corbicula )
F F Crustacean (isopod/amphipod/crayfish/shrimp)
F F Damselfly and dragonfly larvae
F F Dipterans (true flies)
F F Mayfly larvae (Ephemeroptera [E])
F F Megaloptera (alderfly, fishfly, dobsonfly larvae)
F F Midges/mosquito larvae
F F Mosquito fish (Gambusia) or mud minnows (Umbra pygmaea)
F F Mussels/Clams (not Corbicula )
F F Other fish
F F Salamanders/tadpoles
F F Snails
F F Stonefly larvae (Plecoptera [P])
F F Tipulid larvae
F F Worms/leeches
13. Streamside Area Ground Surface Condition — streamside area metric (skip for Tidal Marsh Streams and B valley types)
Consider for the
Left Bank (LB) and the Right Bank (RB). Consider storage capacity with regard to both overbank flow and
upland runoff.
LB RB
Ce A Ce A
Little or no alteration to water storage capacity over a majority of the streamside area
C` B i` B
Moderate alteration to water storage capacity over a majority of the streamside area
C` C i` C
Severe alteration to water storage capacity over a majority of the streamside area (examples include: ditches, fill,
soil, compaction, livestock disturbance, buildings, man-made levees, drainage pipes)
14. Streamside Area Water Storage — streamside area metric (skip for Size 1 streams, Tidal Marsh Streams, and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB) of the streamside area.
LB RB
C' A i' A Majority of streamside area with depressions able to pond water >: 6 inches deep
(a B (e B Majority of streamside area with depressions able to pond water 3 to 6 inches deep
C` C i` C Majority of streamside area with depressions able to pond water < 3 inches deep
15. Wetland Presence — streamside area metric (skip for Tidal Marsh Streams)
Consider for the Left Bank (LB) and the Right Bank (RB). Do not consider wetlands outside of the streamside area or within the
normal wetted perimeter of assessment reach.
LB RB
Ca Y (e Y Are wetlands present in the streamside area?
C' N i' N
16. Basef low Contributors — assessment reach metric (skip for size 4 streams and Tidal Marsh Streams)
Check all contributors within the assessment reach or within view of and draining to the assessment reach.
F A Streams and/or springs (jurisdictional discharges)
F B Ponds (include wet detention basins; do not include sediment basins or dry detention basins)
F C Obstruction that passes some flow during low -flow periods within assessment area (beaver dam, bottom -release dam)
F D Evidence of bank seepage or sweating (iron oxidizing bacteria in water indicates seepage)
FIE Stream bed or bank soil reduced (dig through deposited sediment if present)
F F None of the above
17. Basef low Detractors — assessment area metric (skip for Tidal Marsh Streams)
Check all that apply.
F A Evidence of substantial water withdrawals from the assessment reach (includes areas excavated for pump installation)
F B Obstruction not passing flow during low flow periods affecting the assessment reach (ex: watertight dam, sediment deposit)
F C Urban stream (>! 24% impervious surface for watershed)
F D Evidence that the stream -side area has been modified resulting in accelerated drainage into the assessment reach
F E Assessment reach relocated to valley edge
FIF None of the above
18. Shading — assessment reach metric (skip for Tidal Marsh Streams)
Consider aspect. Consider "leaf -on" condition.
C' A Stream shading is appropriate for stream category (may include gaps associated with natural processes)
Ca B Degraded (example: scattered trees)
C' C Stream shading is gone or largely absent
19. Buffer Width — streamside area metric (skip for Tidal Marsh Streams)
Consider "vegetated buffer" and "wooded buffer" separately for left bank (LB) and right bank (RB) starting at the top
of bank out to the first break.
Vegetated
Wooded
LB RB
LB RB
(a A (e A
C' A i' A
>_ 100-feet wide or extends to the edge of the watershed
C' B i' B
C` B (e B
From 50 to < 100-feet wide
C' C i' C
(a C t C
From 30 to < 50-feet wide
C' D i' D
C` D t D
From 10 to < 30-feet wide
C' E i' E
C` E t E
< 10-feet wide or no trees

20. Buffer Structure - streamside area metric (skip for Tidal Marsh Streams)
Consider
for left
bank (LB) and right bank (RB) for Metric 19 ("Vegetated" Buffer Width).
LB
RB
C' A
C' A
Mature forest
C: B
C: B
Non -mature woody vegetation or modified vegetation structure
C
C
Herbaceous vegetation with or without a strip of trees < 10 feet wide
D
D
Maintained shrubs
E
E
Little or no vegetation
21. Buffer Stressors - streamside area metric (skip for Tidal Marsh Streams)
Check all appropriate boxes for left bank (LB) and right bank (RB). Indicate if listed stressor abuts stream (Abuts), does not abut but
is within 30 feet of stream (< 30 feet), or is between 30 to 50 feet of stream (30-50 feet).
If none of the following stressors occurs on either bank, check here and skip to Metric 22: F
Abuts < 30 feet 30-50 feet
LB RB LB RB LB RB
C` A i` A !` A c` A C` A c` A Row crops
B it B B t' B B t' B Maintained turf
C C C C C C Pasture (no livestock)/commercial horticulture
D D D D C: D G D Pasture (active livestock use)
22. Stem Density - streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 ("Wooded" Buffer Width).
LB RB
C: A C: A Medium to high stem density
B B Low stem density
C C No wooded riparian buffer or predominantly herbaceous species or bare ground
23. Continuity of Vegetated Buffer - streamside area metric (skip for Tidal Marsh Streams)
Consider whether vegetated buffer is continuous along stream (parallel). Breaks are areas lacking vegetation > 10-feet wide.
LB RB
C: A C: A The total length of buffer breaks is < 25 percent.
B �` B The total length of buffer breaks is between 25 and 50 percent.
C C The total length of buffer breaks is > 50 percent.
24. Vegetative Composition - First 100 feet of streamside area metric (skip for Tidal Marsh Streams)
Evaluate the dominant vegetation within 100 feet of each bank or to the edge of the watershed (whichever comes first) as it contributes
to assessment reach habitat.
LB RB
C' A C' A Vegetation is close to undisturbed in species present and their proportions. Lower strata composed of native
species, with non-native invasive species absent or sparse.
C: B C: B Vegetation indicates disturbance in terms of species diversity or proportions, but is still largely composed of native
species. This may include communities of weedy native species that develop after clear -cutting or clearing or
communities with non-native invasive species present, but not dominant, over a large portion of the expected strata or
communities missing understory but retaining canopy trees.
C` C C` C Vegetation is severely disturbed in terms of species diversity or proportions. Mature canopy is absent or communities
with non-native invasive species dominant over a large portion of expected strata or communities composed of planted
stands of non -characteristic species or communities inappropriately composed of a single species or no vegetation.
25. Conductivity - assessment reach metric (skip for all Coastal Plain streams)
25a. (` Yes C: No Was a conductivity measurement recorded?
If No, select one of the following reasons. (` No Water C' Other:
25b. Check the box corresponding to the conductivity measurement (units of microsiemens per centimeter).
C` A <46 r B 46 to < 67 t` C 67 to < 79 r D 79 to < 230 C` E >- 230
Notes/Sketch

NC SAM Stream Rating Sheet
Accompanies User Manual Version 2.1
Stream Site Name BR-0123
Stream Category Pal
Notes of Field Assessment Form (Y/N)
Presence of regulatory considerations (Y/N)
Additional stream information/supplementary measurements included (Y/N)
NC SAM feature type (perennial, intermittent, Tidal Marsh Stream)
Date of Evaluation 2/11/2019
Assessor Name/Organization ason/L. Lovingood - Three
NO
NO
NO
Function Class Rating Summary
USACE/
All Streams
NCDWR
Intermittent
(1) Hydrology
(2) Baseflow
(2) Flood Flow
(3) Streamside Area Attenuation
(4) Floodplain Access
(4) Wooded Riparian Buffer
(4) Microtopography
(3) Stream Stability
(4) Channel Stability
(4) Sediment Transport
(4) Stream Geomorphology
(2) Stream/Intertidal Zone Interaction
(2) Longitudinal Tidal Flow
(2) Tidal Marsh Stream Stability
(3) Tidal Marsh Channel Stability
(3) Tidal Marsh Stream Geomorphology
MEDIUM
HIGH
MEDIUM
HIGH
MEDIUM
HIGH
HIGH
LOW
MEDIUM
LOW
MEDIUM
NA
NA
NA
NA
NA
MEDIUM
HIGH
MEDIUM
HIGH
MEDIUM
HIGH
HIGH
LOW
MEDIUM
LOW
MEDIUM
NA
NA
NA
NA
NA
(1) Water Quality
(2) Baseflow
(2) Streamside Area Vegetation
(3) Upland Pollutant Filtration
(3) Thermoregulation
(2) Indicators of Stressors
(2) Aquatic Life Tolerance
(2) Intertidal Zone Filtration
MEDIUM
HIGH
HIGH
HIGH
MEDIUM
YES
HIGH
NA
MEDIUM
HIGH
HIGH
HIGH
MEDIUM
YES
NA
NA
(1) Habitat
(2) In -stream Habitat
(3) Baseflow
(3) Substrate
(3) Stream Stability
(3) In -stream Habitat
(2) Stream -side Habitat
(3) Stream -side Habitat
(3) Thermoregulation
(2) Tidal Marsh In -stream Habitat
(3) Flow Restriction
(3) Tidal Marsh Stream Stability
(4) Tidal Marsh Channel Stability
(4) Tidal Marsh Stream Geomorphology
(3) Tidal Marsh In -stream Habitat
(2) Intertidal Zone Habitat
LOW
LOW
HIGH
LOW
MEDIUM
LOW
HIGH
HIGH
MEDIUM
NA
NA
NA
NA
NA
NA
NA
LOW
LOW
HIGH
LOW
MEDIUM
LOW
HIGH
HIGH
MEDIUM
NA
NA
NA
NA
NA
NA
NA
Overall
MEDIUM
MEDIUM

WETLAND DETERMINATION DATA SHEET — Eastern Mountains and Piedmont Region
Project/Site: BR-0123 - Br. 318 over UT to S. Fork Mitchell River on SR 1319 City/County: Thurmond/Surry Sampling Date: 2/11/2019
Applicant/Owner: NCDOT State: NC Sampling Point: WA WET
Investigator(s): J. Mason, L. Lovingood - Three Oaks Eng. Section, Township, Range: ---
Landform (hillside, terrace, etc.): floodplain Local relief (concave, convex, none): concave Slope (%): 0-2
Subregion (LRR or MLRA): LRR P, MLRA 136 Lat: 36.375308 Long:-80.876088 Datum: NAD 83
Soil Map Unit Name: Colvard and Suches soils, 0 to 3 percent slopes, occasionally flooded (CsA) NW I classification: PEM
Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.)
Are Vegetation X Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes X No
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes X No Is the Sampled Area
Hydric Soil Present? Yes X No within a Wetland?
Wetland Hydrology Present? Yes X No
Remarks:
Vegetation has been disturbed at some point in the past
HYDROLOGY
Yes X No
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required; check all that apply)
_Surface Soil Cracks (B6)
X Surface Water (Al)
_True Aquatic Plants (B14)
_Sparsely Vegetated Concave Surface (B8)
X High Water Table (A2)
—Hydrogen Sulfide Odor (Cl)
—Drainage Patterns (B10)
X Saturation (A3)
X Oxidized Rhizospheres on Living Roots (C3)
_Moss Trim Lines (1316)
—Water Marks (B1)
—Presence of Reduced Iron (C4)
_ Dry -Season Water Table (C2)
_Sediment Deposits (B2)
_Recent Iron Reduction in Tilled Soils (C6)
_Crayfish Burrows (C8)
_ Drift Deposits (B3)
_Thin Muck Surface (C7)
_Saturation Visible on Aerial Imagery (C9)
_Algal Mat or Crust (B4)
_Other (Explain in Remarks)
_Stunted or Stressed Plants (D1)
_ Iron Deposits (135)
X Geomorphic Position (D2)
_ Inundation Visible on Aerial Imagery (137)
—Shallow Aquitard (D3)
—Water-Stained Leaves (139)
_ Microtopographic Relief (D4)
Aquatic Fauna (1313)
X FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? Yes X
No Depth (inches): 1
Water Table Present? Yes X
No Depth (inches): 5
Saturation Present? Yes X
No Depth (inches): 0
Wetland Hydrology Present? Yes X No
includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
Standing water was nearby, but not directly at wetland point
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Sampling Point: WA WET
Tree Stratum (Plot size: Within Wetland)
% Cover Species?
Status
Dominance Test worksheet:
1. Absent
Number of Dominant Species
2.
That Are OBL, FACW, or FAC: 2 (A)
3.
Total Number of Dominant
4.
Species Across All Strata: 3 (B)
5.
Percent of Dominant Species
6.
That Are OBL, FACW, or FAC: 66.7% (A/B)
7.
Prevalence Index worksheet:
=Total Cover
Total % Cover of: Multiply by:
50% of total cover:
20% of total cover:
OBL species 30 x 1 = 30
Sapling/Shrub Stratum (Plot size: Within Wetland)
FACW species 0 x 2 = 0
1. Absent
FAC species 0 x 3 = 0
2.
FACU species 15 x 4 = 60
3.
UPL species 0 x 5 = 0
4.
Column Totals: 45 (A) 90 (B)
5.
Prevalence Index = B/A = 2.00
6.
Hydrophytic Vegetation Indicators:
7.
1 - Rapid Test for Hydrophytic Vegetation
8.
X 2 - Dominance Test is >50%
9.
X 3 - Prevalence Index is 53.0'
=Total Cover
4 - Morphological Adaptations' (Provide supporting
50% of total cover:
20% of total cover:
data in Remarks or on a separate sheet)
Herb Stratum (Plot size: Within Wetland)
Problematic Hydrophytic Vegetation' (Explain)
1. Persicaria hydropiperoides
20 Yes
OBL
'Indicators of hydric soil and wetland hydrology must be
2. Fallopia japonica
10 Yes
FACU
present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
3. Carex lurida 10 Yes OBL
4. Rubus argutus
5 No
FACU
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
5.
more in diameter at breast height (DBH), regardless of
6
height.
7•
Sapling/Shrub - Woody plants, excluding vines, less
8,
than 3 in. DBH and greater than or equal to 3.28 ft (1
9
m) tall.
10.
Herb - All herbaceous (non -woody) plants, regardless
11.
of size, and woody plants less than 3.28 ft tall.
45 =Total Cover
Woody Vine - All woody vines greater than 3.28 ft in
50% of total cover: 23
20% of total cover:
9
height.
Woody Vine Stratum (Plot size: Within Wetland )
1. Absent
2.
3.
4.
5.
Hydrophytic
=Total Cover
Vegetation
50% of total cover:
20% of total cover:
Present? Yes X No
Remarks: (Include photo numbers here or on a separate sheet.)
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL Sampling Point: WA WET
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix
Redox Features
(inches) Color (moist) %
Color (moist) % Type' Loc2 Texture
Remarks
0-12 10YR 4/1 80
10YR 3/4 20 C PUM Loamy/Clayey Distinct redox concentrations
'Type: C=Concentration, D=Depletion, RM=Reduced
Matrix, MS=Masked Sand Grains. 2Location:
PL=Pore Lining, M=Matrix.
Hydric Soil Indicators:
Indicators for Problematic Hydric Soils3:
_ Histosol (Al)
_ Polyvalue Below Surface (S8) (MLRA 147, 148)
_ 2 cm Muck (A10) (MLRA 147)
_ Histic Epipedon (A2)
—Thin Dark Surface (S9) (MLRA 147, 148)
—Coast Prairie Redox (A16)
_ Black Histic (A3)
—Loamy Mucky Mineral (F1) (MLRA 136)
(MLRA 147, 148)
_ Hydrogen Sulfide (A4)
—Loamy Gleyed Matrix (F2)
—Piedmont Floodplain Soils (F19)
_ Stratified Layers (A5)
X Depleted Matrix (F3)
(MLRA 136, 147)
_ 2 cm Muck (A10) (LRR N)
_ Redox Dark Surface (F6)
_ Red Parent Material (F21)
_ Depleted Below Dark Surface (A11)
—Depleted Dark Surface (F7)
(outside MLRA 127, 147, 148)
—Thick Dark Surface (Al2)
_ Redox Depressions (F8)
—Very Shallow Dark Surface (F22)
—Sandy Mucky Mineral (S1)
_ Iron -Manganese Masses (F12) (LRR N,
—Other (Explain in Remarks)
_ Sandy Gleyed Matrix (S4)
MLRA 136)
_ Sandy Redox (S5)
_ Umbric Surface (F13) (MLRA 122, 136)
3Indicators of hydrophytic vegetation and
—Stripped Matrix (S6)
—Piedmont Floodplain Soils (F19) (MLRA 148)
wetland hydrology must be present,
Dark Surface (S7)
Red Parent Material (F21) (MLRA 127, 147, 148)
unless disturbed or problematic.
Restrictive Layer (if observed):
Type:
Depth (inches):
Hydric Soil Present? Yes No
Remarks:
This data sheet is revised from Eastern Mountains and Piedmont Regional Supplement Version 2.0 to include the NRCS Field Indicators of Hydric
Soils, Version 8.0, 2016.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA SHEET — Eastern Mountains and Piedmont Region
Project/Site: BR-0123 - Br. 318 over UT to S. Fork Mitchell River on SR 1319 City/County: Thurmond/Surry Sampling Date: 2/11/2019
Applicant/Owner: NCDOT State: NC Sampling Point: WA UPL
Investigator(s): J. Mason, L. Lovingood - Three Oaks Eng. Section, Township, Range: ---
Landform (hillside, terrace, etc.): hillslope Local relief (concave, convex, none): none Slope (%): 1-3
Subregion (LRR or MLRA): LRR P, MLRA 136 Lat: 36.374767 Long:-80.876492 Datum: NAD 83
Soil Map Unit Name: Colvard and Suches soils, 0 to 3 percent slopes, occasionally flooded (CsA) NW I classification: Upland
Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes X No
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes No X Is the Sampled Area
Hydric Soil Present? Yes No X within a Wetland? Yes No X
Wetland Hydrology Present? Yes No X
Remarks:
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required; check all that apply)
_Surface Soil Cracks (B6)
_Surface Water (Al)
_True Aquatic Plants (B14)
_Sparsely Vegetated Concave Surface (B8)
_ High Water Table (A2)
—Hydrogen Sulfide Odor (Cl)
—Drainage Patterns (B10)
_Saturation (A3)
_Oxidized Rhizospheres on Living Roots (C3)
_Moss Trim Lines (1316)
—Water Marks (B1)
—Presence of Reduced Iron (C4)
_ Dry -Season Water Table (C2)
_Sediment Deposits (B2)
_Recent Iron Reduction in Tilled Soils (C6)
_Crayfish Burrows (C8)
_ Drift Deposits (B3)
_Thin Muck Surface (C7)
_Saturation Visible on Aerial Imagery (C9)
_Algal Mat or Crust (B4)
_Other (Explain in Remarks)
_Stunted or Stressed Plants (D1)
_Iron Deposits (135)
_Geomorphic Position (D2)
_ Inundation Visible on Aerial Imagery (137)
—Shallow Aquitard (D3)
—Water-Stained Leaves (139)
_ Microtopographic Relief (D4)
Aquatic Fauna (1313)
FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? Yes
No X Depth (inches): 0
Water Table Present? Yes
No X Depth (inches): 16
Saturation Present? Yes
No X Depth (inches): 16
Wetland Hydrology Present? Yes No X
includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Sampling Point: WA UPL
ADs01ute
uominant
Tree Stratum (Plot size:
30 feet )
% Cover
Species?
1.
Prunus serotina
25
Yes
2.
Acer rubrum
10
Yes
3.
4.
5.
6.
7.
35
=Total Cover
50% of total cover:
18 20% of total cover:
Sapling/Shrub Stratum (Plot size: 30 feet
)
1.
Ligustrum sinense
10
Yes
2.
Fagus grandifolia
5
Yes
3.
4.
5.
6.
7.
8.
9.
15
=Total Cover
50% of total cover:
8 20% of total cover:
Herb Stratum (Plot size:
30 feet )
1.
Rubus argutus
40
Yes
2.
Phytolacca americana
5
No
3.
4.
5.
6.
7.
8.
9.
10.
11.
50% of total cover: 23
Woody Vine Stratum (Plot size: 30 feet )
1. Lonicera japonica
2.
3. _
4.
5.
iaicatc
Status
FACU
FAC
7
FACU
FACU
3
FACU
FACU
45 =Total Cover
20% of total cover: 9
10 Yes FACU
10 =Total Cover
50% of total cover: 5 20% of total cover: 2
Remarks: (Include photo numbers here or on a separate sheet.)
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 1 (A)
Total Number of Dominant
Species Across All Strata: 6 (B)
Percent of Dominant Species
That Are OBL, FACW, or FAC: 16.7% (A/B)
Prevalence Index worksheet:
Total % Cover of: Multiply by:
OBL species 0 x 1 = 0
FACW species 0 x 2 = 0
FAC species 10 x 3 = 30
FACU species 95 x 4 = 380
UPL species 0 x 5 = 0
Column Totals: 105 (A) 410 (B)
Prevalence Index = B/A = 3.90
Hydrophytic Vegetation Indicators:
_ 1 - Rapid Test for Hydrophytic Vegetation
-2 - Dominance Test is >50%
-3 - Prevalence Index is :53.0'
4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
Problematic Hydrophytic Vegetation' (Explain)
'Indicators of hydric soil and wetland hydrology must be
present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (DBH), regardless of
height.
Sapling/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft (1
m) tall.
Herb - All herbaceous (non -woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
Woody Vine - All woody vines greater than 3.28 ft in
height.
Hydrophytic
Vegetation
Present? Yes No X
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL Sampling Point: WA UPL
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix
Redox Features
(inches) Color (moist) %
Color (moist) % Type' Loc2
Texture Remarks
0-6 10YR 4/3 90
10YR 4/2 10 D M
Loamy/Clayey
6-12 10YR 4/3 70
2.5Y 5/2 15 D M
Loamy/Clayey
10YR 3/4 15 C M
Faint redox concentrations
'Type: C=Concentration, D=Depletion, RM=Reduced
Matrix, MS=Masked Sand Grains.
2Location: PL=Pore Lining, M=Matrix.
Hydric Soil Indicators:
Indicators for Problematic Hydric Soils3:
_ Histosol (Al)
_ Polyvalue Below Surface (S8) (MLRA 147, 148) _ 2 cm Muck (A10) (MLRA 147)
_ Histic Epipedon (A2)
—Thin Dark Surface (S9) (MLRA 147, 148) —Coast Prairie Redox (A16)
_ Black Histic (A3)
—Loamy Mucky Mineral (F1) (MLRA 136) (MLRA 147, 148)
_ Hydrogen Sulfide (A4)
—Loamy Gleyed Matrix (F2)
—Piedmont Floodplain Soils (F19)
_ Stratified Layers (A5)
—Depleted Matrix (F3)
(MLRA 136, 147)
_ 2 cm Muck (A10) (LRR N)
_ Redox Dark Surface (F6)
_ Red Parent Material (F21)
_ Depleted Below Dark Surface (A11)
—Depleted Dark Surface (F7)
(outside MLRA 127, 147, 148)
—Thick Dark Surface (Al2)
_ Redox Depressions (F8)
—Very Shallow Dark Surface (F22)
—Sandy Mucky Mineral (S1)
_ Iron -Manganese Masses (F12) (LRR N,
—Other (Explain in Remarks)
_ Sandy Gleyed Matrix (S4)
MLRA 136)
_ Sandy Redox (S5)
_ Umbric Surface (F13) (MLRA 122, 136)
3Indicators of hydrophytic vegetation and
—Stripped Matrix (S6)
—Piedmont Floodplain Soils (F19) (MLRA 148) wetland hydrology must be present,
Dark Surface (S7)
Red Parent Material (F21) (MLRA 127,
147, 148) unless disturbed or problematic.
Restrictive Layer (if observed):
Type:
Depth (inches):
Hydric Soil Present? Yes No X
Remarks:
This data sheet is revised from Eastern Mountains and Piedmont Regional Supplement Version 2.0 to include the NRCS Field Indicators of Hydric
Soils, Version 8.0, 2016.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

NC WAM WETLAND ASSESSMENT FORM
Accompanies User Manual Version 5
USACE AID#: NCDWR #:
Project Name BR-0123 Date of Evaluation 2/11/2019
Applicant/Owner Name NCDOT Wetland Site Name WA
Wetland Type Non -Tidal Freshwater Marsh Assessor Name/Organization J. Mason/L. Lovingood - 3Oaks
Level III Ecoregion Piedmont Nearest Named Water Body South Fork Mitchell River
River Basin Yadkin-PeeDee USGS 8-Digit Catalogue Unit 03040101
County Surry NCDWR Region Mooresville
C Yes C: No Precipitation within 48 hrs? Latitude/Longitude (deci-degrees) 36.375308,-80.876088
Evidence of stressors affecting the assessment area (may not be within the assessment area)
Please circle and/or make note on last page if evidence of stressors is apparent. Consider departure from reference, if
appropriate, in recent past (for instance, approximately within 10 years). Noteworthy stressors include, but are not limited
to the following.
• Hydrological modifications (examples: ditches, dams, beaver dams, dikes, berms, ponds, etc.)
• Surface and sub -surface discharges into the wetland (examples: discharges containing obvious pollutants, presence of nearby
septic tanks, underground storage tanks (USTs), hog lagoons, etc.)
• Signs of vegetation stress (examples: vegetation mortality, insect damage, disease, storm damage, salt intrusion, etc.)
• Habitat/plant community alteration (examples: mowing, clear -cutting, exotics, etc.)
Is the assessment area intensively managed? C Yes C: No
Regulatory Considerations - Were regulatory considerations evaluated? Ci Yes C No If Yes, check all that apply to the assessment area.
F Anadromous fish
F Federally protected species or State endangered or threatened species
F NCDWR riparian buffer rule in effect
F Abuts a Primary Nursery Area (PNA)
F Publicly owned property
F N.C. Division of Coastal Management Area of Environmental Concern (AEC) (including buffer)
F Abuts a stream with a NCDWQ classification of SA or supplemental classifications of HQW, ORW, or Trout
F Designated NCNHP reference community
F Abuts a 303(d)-listed stream or a tributary to a 303(d)-listed stream
What type of natural stream is associated with the wetland, if any? (check all that apply)
C Blackwater
C: Brownwater
F Tidal (if tidal, check one of the following boxes) C' Lunar C Wind C Both
Is the assessment area on a coastal island? C Yes C: No
Is the assessment area's surface water storage capacity or duration substantially altered by beaver? C Yes C: No
Does the assessment area experience overbank flooding during normal rainfall conditions? C Yes 0 No
Ground Surface Condition/Vegetation Condition — assessment area condition metric
Check a box in each column. Consider alteration to the ground surface (GS) in the assessment area and vegetation structure
(VS) in the assessment area. Compare to reference wetland if applicable (see User Manual). If a reference is not applicable,
then rate the assessment area based on evidence of an effect.
GS VS
C: A C A Not severely altered
f B C: B Severely altered over a majority of the assessment area (ground surface alteration examples: vehicle tracks, excessive
sedimentation, fire -plow lanes, skidder tracks, bedding, fill, soil compaction, obvious pollutants) (vegetation structure
alteration examples: mechanical disturbance, herbicides, salt intrusion [where appropriate], exotic species, grazing,
less diversity [if appropriate], hydrologic alteration)
2. Surface and Sub -Surface Storage Capacity and Duration — assessment area condition metric
Check a box in each column. Consider surface storage capacity and duration (Surf) and sub -surface storage capacity and
duration (Sub). Consider both increase and decrease in hydrology. A ditch s 1 foot deep is considered to affect surface water only,
while a ditch > 1 foot deep is expected to affect both surface and sub -surface water. Consider tidal flooding regime, if applicable.
Surf Sub
Ci A C: A Water storage capacity and duration are not altered.
f B r B Water storage capacity or duration are altered, but not substantially (typically, not sufficient to change vegetation).
C' C r C Water storage capacity or duration are substantially altered (typically, alteration sufficient to result in vegetation
change) (examples: draining, flooding, soil compaction, filling, excessive sedimentation, underground utility lines).
3. Water Storage/Surface Relief — assessment area/wetland type condition metric (skip for all marshes)
Check a box in each column for each group below. Select the appropriate storage for the assessment area (AA) and the wetland
type (WT).
AA WT
3a. C A r A Majority of wetland with depressions able to pond water > 1 foot deep
C" B r B Majority of wetland with depressions able to pond water 6 inches to 1 foot deep
C: C C: C Majority of wetland with depressions able to pond water 3 to 6 inches deep
C D r D Depressions able to pond water < 3 inches deep
3b. C A Evidence that maximum depth of inundation is greater than 2 feet
C` B Evidence that maximum depth of inundation is between 1 and 2 feet
C: C Evidence that maximum depth of inundation is less than 1 foot

4. Soil Texture/Structure — assessment area condition metric (skip for all marshes)
Check a box from each of the three soil property groups below. Dig soil profile in the dominant assessment area landscape
feature. Make soil observations within the 12 inches. Use most recent National Technical Committee for Hydric Soils guidance for
regional indicators.
4a. r A Sandy soil
re B Loamy or clayey soils exhibiting redoximorphic features (concentrations, depletions, or rhizospheres)
r C Loamy or clayey soils not exhibiting redoximorphic features
I— D Loamy or clayey gleyed soil
r E Histosol or histic epipedon
4b. re A Soil ribbon < 1 inch
r B Soil ribbon >— 1 inch
4c. re A No peat or muck presence
r B A peat or muck presence
5. Discharge into Wetland —opportunity metric
Check a box in each column. Consider surface pollutants or discharges (Surf) and sub -surface pollutants or discharges (Sub).
Examples of sub -surface discharges include presence of nearby septic tank, underground storage tank (UST), etc.
Surf Sub
0 A (: A Little or no evidence of pollutants or discharges entering the assessment area
(' B (` B Noticeable evidence of pollutants or discharges entering the wetland and stressing, but not overwhelming the
treatment capacity of the assessment area
(` C (` C Noticeable evidence of pollutants or discharges (pathogen, particulate, or soluble) entering the assessment area and
potentially overwhelming the treatment capacity of the wetland (water discoloration, dead vegetation, excessive
sedimentation, odor)
6. Land Use — opportunity metric (skip for non -riparian wetlands)
Check all that apply (at least one box in each column). Evaluation involves a GIS effort with field adjustment. Consider sources
draining to assessment area within entire upstream watershed (WS), within 5 miles and within the watershed draining to the
assessment area (5M), and within 2 miles and within the watershed draining to the assessment area (2M). Effective riparian buffers
are considered to be 50 feet wide in the Coastal Plain and Piedmont ecoregions and 30 feet wide in the Blue Ridge Mountains ecoregion.
WS 5M 2M
F A F A F A >_ 10% impervious surfaces
F B F B F B Confined animal operations (or other local, concentrated source of pollutants)
FI C F C F C >_ 20% coverage of pasture
FI D FI D FI D z 20% coverage of agricultural land (regularly plowed land)
F E F E F E >_ 20% coverage of maintained grass/herb
F F F F F F >_ 20% coverage of clear-cut land
F G F G F G Little or no opportunity to improve water quality. Lack of opportunity may result from little or no disturbance in
the watershed or hydrologic alterations that prevent dainage and/or overbank flow from affectio the
assessment area.
Wetland Acting as Vegetated Buffer — assessment area/wetland complex condition metric (skip for non -riparian wetlands)
7a. Is assessment area within 50 feet of a tributary or other open water?
(: Yes r No If Yes, continue to 7b. If No, skip to Metric 8.
7b. How much of the first 50 feet from the bank is weltand? (Wetland buffer need only be present on one side of the water body. Make
buffer judgment based on the average width of wetland. Record a note if a portion of the buffer has been removed or disturbed.)
(` A >_ 50 feet
(: B From 30 to < 50 feet
C C From 15 to < 30 feet
f - D From 5 to < 15 feet
C E < 5 feet or buffer bypassed by ditches
7c. Tributary width. If the tributary is anastomosed, combine widths of channels/braids for a total width.
C <_ 15-feet wide (: > 15-feet wide (' Other open water (no tributary present)
7d. Do roots of assessment area vegetation extend into the bank of the tributary/open water?
(` Yes (: No
7e. Is tributary or other open water sheltered or exposed?
(Ta Sheltered — adjacent open water with width < 2500 feet and no regular boat traffic.
(` Exposed — adjacent open water with width >_ 2500 feet or regular boat traffic.
8. Wetland Width at the Assessment Area — wetland type/wetland complex condition metric (evaluate WT for all marshes
and Estuarine Woody Wetland only; evaluate WC for Bottomland Hardwood Forest, Headwater Forest, and Riverine Swamp
Forest only)
Check a box in each column. Select the average width for the wetland type at the assessment area (WT) and the wetland complex at the
assessment area (WC). See User Manual for WT and WC boundaries.
WT WC
C A
C` A
> 100 feet
C B
C` B
From 80 to < 100 feet
(` C
(` C
From 50 to < 80 feet
f - D
C' D
From 40 to < 50 feet
(` E
(` E
From 30 to < 40 feet
(: F
F
From 15 to < 30 feet
f G
C` G
From 5 to < 15 feet
(` H
(` H
< 5 feet

9. Inundation Duration — assessment area condition metric (skip for non -riparian wetlands)
Answer for assessment area dominant landform.
f -A Evidence of short -duration inundation (< 7 consecutive days)
(` B Evidence of saturation, without evidence of inundation
{: C Evidence of long -duration inundation or very long -duration inundation (7 to 30 consecutive days or more)
10. Indicators of Deposition —assessment area condition metric (skip for non -riparian wetlands and all marshes)
Consider recent deposition only (no plant growth since deposition).
f -A Sediment deposition is not excessive, but at approximately natural levels.
0 B Sediment deposition is excessive, but not overwhelming the wetland.
C C Sediment deposition is excessive and is overwhelming the wetland.
11. Wetland Size — wetland type/wetland complex condition metric
Check a box in each column. Involves a GIS effort with field adjustment. This metric evaluates three aspects of the wetland area: the
size of the wetland type (WT), the size of the wetland complex (WC), and the size of the forested wetland (FW) (if applicable, see User
Manual). See the User Manual for boundaries of these evaluation areas. If assessment area is clear-cut, select "K" for the FW column.
WT WC FW (if applicable)
(` A (' A (' A >_ 500 acres
B ( B B From 100 to < 500 acres
(- C r C ' C From 50 to < 100 acres
(` D (' D (' D From 25 to < 50 acres
(- E r E ( E From 10 to < 25 acres
(` F (' F (' F From 5 to < 10 acres
(' G (' G (' G From 1 to < 5 acres
(- H r H ( H From 0.5 to < 1 acre
(` I r I (' I From 0.1 to < 0.5 acre
fo J t+ J ( J From 0.01 to < 0.1 acre
r K C' K (i K < 0.01 acre or assessment area is clear-cut
12. Wetland Intactness — wetland type condition metric (evaluate for Pocosins only)
(- A Pocosin is the full extent (>_ 90%) of its natural landscape size.
(` B Pocosin is < 90% of the full extent of its natural landscape size.
13. Connectivity to Other Natural Areas — landscape condition metric
13a. Check appropriate box(es) (a box may be checked in each column). Involves a GIS effort with field adjustment. This
evaluates whether the wetland is well connected (Well) and/or loosely connected (Loosely) to the landscape patch, the contiguous
metric naturally vegetated area and open water (if appropriate). Boundaries are formed by four -lane roads, regularly maintained utility
line corridors the width of a four -lane road or wider, urban landscapes, fields (pasture open and agriculture), or water > 300 feet wide.
Well Loosely
(' A (- A >_ 500 acres
(' B r B From 100 to < 500 acres
( C (. C From 50 to < 100 acres
r D (' D From 10 to < 50 acres
ti E r E < 10 acres
(' F r F Wetland type has a poor or no connection to other natural habitats
13b. Evaluate for marshes only.
ti Yes (— No Wetland type has a surface hydrology connection to open waters/stream or tidal wetlands.
14. Edge Effect — wetland type condition metric (skip for all marshes and Estuarine Woody Wetland)
May involve a GIS effort with field adjustment. Estimate distance from wetland type boundary to artificial edges. Artificial edges include
non -forested areas >_ 40 feet wide such as fields, development, roads, regularly maintained utility line corridors and clear -cuts. Consider
the eight main points of the compass. Artificial edge occurs within 150 feet in how many directiions? If the assessment area is clear-cut,
select option "C."
(" A 0
(` B 1 to 4
(OR C 5to8
15. Vegetative Composition — assessment area condition metric (skip for all marshes and Pine Flat)
(` A Vegetation is close to reference condition in species present and their proportions. Lower strata composed of appropriate
species, with exotic plants absent or sparse within the assessment area.
(` B Vegetation is different from reference condition in species diversity or proportions, but still largely composed of native species
characteristic of the wetland type. This may include communities of weedy native species that develop after clearcutting or
clearing. It also includes communities with exotics present, but not dominant, over a large portion of the expected strata.
ti C Vegetation severely altered from reference in composition, or expected species are unnaturally absent (planted stands of non -
characteristic species or at least one stratum inappropriately composed of a single species), or exotic species are dominant in
at least one stratum.
16. Vegetative Diversity — assessment area condition metric (evaluate for Non -tidal Freshwater Marsh only)
(' A Vegetation diversity is high and is composed primarily of native species (<10% cover of exotics).
fi B Vegetation diversity is low or has > 10% to 50% cover of exotics.
(-" C Vegetation is dominated by exotic species (>50% cover of exotics).

17. Vegetative Structure - assessment area/wetland type condition metric
17a. Is vegetation present?
(i Yes C No If Yes, continue to 17b. If No, skip to Metric 18.
17b. Evaluate percent coverage of assessment area vegetation for all marshes only. Skip to 17c for non -marsh wetlands.
ti A >_ 25% coverage of vegetation
q ' B < 25% coverage of vegetation
17c. Check a box in each column for each stratum. Evaluate this portion of the metric for non -marsh wetlands. Consider structure
in airspace above the assessment area (AA) and the wetland type (WT) separately.
AA WT
Q C A A Canopy closed, or nearly closed, with natural gaps associated with natural processes
m(- B B Canopy present, but opened more than natural gaps
U (e- C Ci C Canopy sparse or absent
o C A C A Dense mid-story/sapling layer
a
( B C B Moderate density mid-story/sapling layer
(+ C (o- C Mid-story/sapling layer sparse or absent
C A C A Dense shrub layer
L (� B
( B
Moderate density shrub layer
co ( C
(_ C
Shrub layer sparse or absent
C A
C A
Dense herb layer
C B
C B
Moderate density herb layer
(+ C
(i C
Herb layer sparse or absent
18. Snags - wetland type condition metric (skip for all marshes)
C A Large snags (more than one) are visible (> 12-inches DBH, or large relative to species present and landscape stability).
to- B Not A
19. Diameter Class Distribution - wetland type condition metric (skip for all marshes)
C A Majority of canopy trees have stems > 6 inches in diameter at breast height (DBH); many large trees (> 12 inches DBH) are
present.
( B Majority of canopy trees have stems between 6 and 12 inches DBH, few are > 12-inch DBH.
Co- C Majority of canopy trees are < 6 inches DBH or no trees.
20. Large Woody Debris - wetland type condition metric (skip for all marshes)
Include both natural debris and man -placed natural debris.
(' A Large logs (more than one) are visible (> 12 inches in diameter, or large relative to species present and landscape stability).
(i B Not A
21. Vegetation/Open Water Dispersion - wetland type/open water condition metric (evaluate for Non -Tidal Freshwater
Marsh only)
Select the figure that best describes the amount of interspersion between vegetation and open water in the growing season. Patterned
areas indicate vegetated areas, while solid white areas indicate open water.
d A k+B CC (� D
C�
1. .01 '•'.+ L - � "�... J�i '�-_e' R't it
22. Hydrologic Connectivity - assessment area condition metric (evaluate for riparian wetlands and Salt/Brackish Marsh only)
Examples of activities that may severely alter hydrologic connectivity include intensive ditching, fill, sedimentation, channelization,
diversion, man-made berms, beaver dams, and stream incision. Documentation required if evaluated as B, C, or D.
(i A Overbank and overland flow are not severely altered in the assessment area.
(- B Overbank flow is severely altered in the assessment area.
(- C Overland flow is severely altered in the assessment area.
C D Both overbank and overland flow are severely altered in the assessment area.
Notes

NC WAM Wetland Rating Sheet
Accompanies User Manual
Version 5.0
Wetland Site Name WA
Date
2/11/2019
Wetland Type Non -Tidal Freshwater Marsh
Assessor Name/Organization Mason/L. Lovingood - 30�
Notes on Field Assessment Form (Y/N)
NO
Presence of regulatory considerations (Y/N)
NO
Wetland is intensively managed (Y/N)
NO
Assessment area is located within 50 feet of a natural tributary or other open water (Y/N)
YES
Assessment area is substantially altered by beaver (Y/N)
NO
Assessment area experiences overbank flooding during normal rainfall conditions
(Y/N)
NO
Assessment area is on a coastal island (Y/N)
NO
Sub -function Rating Summary
Function Sub -function
Metrics
Rating
Hydrology Surface Storage and Retention
Condition
NA
Sub -Surface Storage and Retention
Condition
NA
Water Quality Pathogen Change
Condition
NA
Condition/Opportunity
NA
Opportunity Presence? (Y/N)
NA
Particulate Change
Condition
NA
Condition/Opportunity
NA
Opportunity Presence? (Y/N)
NA
Soluble Change
Condition
NA
Condition/Opportunity
NA
Opportunity Presence? (Y/N)
NA
Physical Change
Condition
NA
Condition/Opportunity
NA
Opportunity Presence? (Y/N)
NA
Pollution Change
Condition
NA
Condition/Opportunity
NA
Opportunity Presence? (Y/N)
NA
Habitat Physical Structure
Condition
LOW
Landscape Patch Structure
Condition
LOW
Vegetation Composition
Condition
MEDIUM
Function Rating Summary
Function Metrics/Notes
Rating
Hydrology Condition
HIGH
Water Quality Condition
MEDIUM
Condition/Opportunity
HIGH
Opportunity Presence? (Y/N)
YES
Habitat Condition
LOW
Overall Wetland Rating MEDIUM

Appendix C
JD Request Form
PJD Form

urisdictional Determination Reauest
US Army Corps
of Engineers
Mminglon Distnd
This form is intended for use by anyone requesting a jurisdictional determination (JD) from the
U.S. Army Corps of Engineers, Wilmington District (Corps). Please include all supporting
information, as described within each category, with your request. You may submit your request
via mail, electronic mail, or facsimile. Requests should be sent to the appropriate project
manager of the county in which the property is located. A current list of project managers by
assigned counties can be found on-line at:
http://www.saw.usace.anny.mil/Missions/Re u�ryPermitProgram/Contact/CounlyLocator.aspx,
by calling 910-251-4633, or by contacting any of the field offices listed below. Once your
request is received you will be contacted by a Corps project manager.
ASHEVILLE & CHARLOTTE REGULATORY
FIELD OFFICES
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
General Number: [phone]
Fax Number: [phone]
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
General Number: [phone]
Fax Number: [phone]
INSTRUCTIONS:
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
2407 West Fifth Street
Washington, North Carolina 27889
General Number: [phone]
Fax Number: [phone]
WILMINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
General Number: 910-251-4633
Fax Number: [phone]
All requestors must complete Parts A, B, C, D, E, F and G.
NOTE TO CONSULTANTS AND AGENCIES: If you are requesting a JD on behalf of a
paying client or your agency, please note the specific submittal requirements in Part H.
NOTE ON PART D — PROPERTY OWNER AUTHORIZATION: Please be aware that
all JD requests must include the current property owner authorization for the Corps to
proceed with the determination, which may include inspection of the property when
necessary. This form must be signed by the current property owner(s) or the owner(s)
authorized agent to be considered a complete request.
NOTE ON PART D - NCDOT REQUESTS: Property owner authorization/notification for
JD requests associated with North Carolina Department of Transportation (NCDOT)
projects will be conducted according to the current NCDOT/USACE protocols.
NOTE TO USDA PROGRAM PARTICIPANTS: A Corps approved or preliminary JD
may not be valid for the wetland conservation provisions of the Food Security Act of
1985. If you or your tenant are USDA Program participants, or anticipate participation in
USDA programs, you should also request a certified wetland determination from the local
office of the Natural Resources Conservation Service, prior to starting work.
Version: May 2017 Page 1

Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: Multiple Parcels
City, State:
Thurmond, NC
County: S u rry
Parcel Index Number(s) (PIN): Multiple PIN's
B. REQUESTOR INFORMATION
Name: Ron Johnson
Mailing Address: 1598 Mail Service Center
Raleigh, NC 27699-1598
Telephone Number: 919-368-7590
Electronic Mail Address: rgjohnson1 [e-mail]
Select one:
❑ I am the current property owner.
❑ I am an Authorized Agent or Environmental Consultant'
❑ Interested Buyer or Under Contract to Purchase
❑ Other, please explain.
C. PROPERTY OWNER INFORMATION
Name: Multiple Property Owners
Mailing Address:
Telephone Number:
Electronic Mail Address:
1 Must provide completed Agent Authorization Form/Letter.
2 Documentation of ownership also needs to be provided with request (copy of Deed, County GIS/Parcel/Tax Record).
Version: May 2017 Page 2

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION',4
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
Print Name
Capacity: ❑ Owner ❑ Authorized Agents
Date
Signature
E. REASON FOR JD REQUEST: (Check as many as applicable)
I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all aquatic resources.
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
✓❑ I intend to construct/develop a projector perform activities on this parcel which may
require authorization from the Corps, and the JD would be used to avoid and minimize
impacts to jurisdictional aquatic resources and as an initial step in a future permitting
process.
❑ I intend to construct/develop a projector perform activities on this parcel which may
require authorization from the Corps; this request is accompanied by my permit application
and the JD is to be used in the permitting process.
I intend to construct/develop a projector perform activities in a navigable water of the
U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of
the tide.
❑ A Corps JD is required in order obtain my local/state authorization.
❑ I intend to contest jurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not exist over the aquatic resource on the parcel.
❑ I believe that the site may be comprised entirely of dry land.
❑ Other:
For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
If there are multiple parcels owned by different parties, please provide the following for each additional parcel on a
continuation sheet.
5 Must provide agent authorization form/letter signed by owner(s).
Version: May 2017 Page 3

Jurisdictional Determination Request
F. JURISDICTIONAL DETERMINATION (JD) TYPE (Select One)
❑✓ I am requesting that the Corps provide a preliminary JD for the property identified herein.
A Preliminary Jurisdictional Determination (PJD) provides an indication that there may
be "waters of the United States" or "navigable waters of the United States"on a property.
PJDs are sufficient as the basis for permit decisions. For the purposes of permitting, all
waters and wetlands on the property will be treated as if they are jurisdictional "waters of
the United States". PJDs cannot be appealed (33 C.F.R. 331.2); however, a PJD is
"preliminary" in the sense that an approved JD can be requested at any time. PJDs do
not expire.
❑ I am requesting that the Corps provide an approved JD for the property identified herein.
An Approved Jurisdictional Determination (AJD) is a determination that
jurisdictional "waters of the United States" or "navigable waters of the United
States" are either present or absent on a site. An approved JD identifies the limits of
waters on a site determined to be jurisdictional under the Clean Water Act and/or
Rivers and Harbors Act. Approved JDs are sufficient as the basis for permit
decisions. AJDs are appealable (33 C.F.R. 331.2). The results of the AJD will be
posted on the Corps website. A landowner, permit applicant, or other "affected
party" (33 C.F.R. 331.2) who receives an AJD may rely upon the AJD for five years
(subject to certain limited exceptions explained in Regulatory Guidance Letter 05-
02).
❑ I am unclear as to which JD I would like to request and require additional information
to inform my decision.
G. ALL REQUESTS
Map of Property or Project Area. This Map must clearly depict the boundaries of the
review area.
✓❑ Size of Property or Review Area 16.6 acres.
❑ The property boundary (or review area boundary) is clearly physically marked on the site.
Version: May 2017 Page 4

Jurisdictional Determination Request
H. REQUESTS FROM CONSULTANTS
❑✓ Project Coordinates (Decimal Degrees): Latitude:
Longitude
36.374633
-80.876551
❑� A legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than l 1x17 and should contain the following: (Corps
signature of submitted survey plats will occur after the submitted delineation map has been
reviewed and approved).6
■ North Arrow
■ Graphical Scale
■ Boundary of Review Area
■ Date
■ Location of data points for each Wetland Determination Data Form or tributary
assessment reach.
For Approved Jurisdictional Determinations:
■ Jurisdictional wetland features should be labeled as Wetland Waters of the US, 404
wetlands, etc. Please include the acreage of these features.
■ Jurisdictional non -wetland features (i.e. tidal/navigable waters, tributaries,
impoundments) should be labeled as Non -Wetland Waters of the US, stream, tributary,
open water, relatively permanent water, pond, etc. Please include the acreage or linear
length of each of these features as appropriate.
■ Isolated waters, waters that lack a significant nexus to navigable waters, or non -
jurisdictional upland features should be identified as Non -Jurisdictional. Please
include a justification in the label regarding why the feature is non jurisdictional (i.e.
"Isolated", "No Significant Nexus", or "Upland Feature"). Please include the acreage
or linear length of these features as appropriate.
For Preliminary Jurisdictional Determinations:
Wetland and non -wetland features should not be identified as Jurisdictional, 404,
Waters of the United States, or anything that implies jurisdiction. These features can be
identified as Potential Waters of the United States, Potential Non -wetland Waters of
the United States, wetland, stream, open water, etc. Please include the acreage and
linear length of these features as appropriate.
Completed Wetland Determination Data Forms for appropriate region
(at least one wetland and one upland form needs to be completed for each wetland type)
6 Please refer to the guidance document titled "Survey Standards for Jurisdictional Determinations" to ensure that the
supplied map meets the necessary mapping standards. http://www.saw.usace.army.mil/Missions/Re ug latory-Permit-
Pro,gram/Jurisdiction/
Version: May 2017 Page 5

Jurisdictional Determination Request
✓❑ Completed appropriate Jurisdictional Determination form
• PJDs, please complete a Preliminary Jurisdictional Determination Form' and include the
Aquatic Resource Table
• AJDs, please complete an Approved Jurisdictional Determination Form'
❑ Vicinity Map
✓❑ Aerial Photograph
✓❑ USGS Topographic Map
❑ Soil Survey Map
❑ Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
❑ Landscape Photos (if taken)
NCWAM and/or NCWAM Assessment Forms and Rating Sheets
❑✓ NC Division of Water Resources Stream Identification Forms
❑ Other Assessment Forms
' www.saw.usace.army.mil/Portals/59/docs/repulatorv/re,gdocs/JD/RGL 08-02_App_A_Prelim _JD_Form _fillable.pdf
' Please see http://www.saw.usace.army.mil/Missions/Re ug latory-Permit-Program/Jurisdiction/
Principal Purpose: The information that you provide will be used in evaluating your request to determine
whether there are any aquatic resources within the proj ect area subject to federal jurisdiction under the regulatory
authorities referenced above.
Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local
government agencies, and the public, and may be made available as part of a public notice as required by federal
law. Your name and property location where federal jurisdiction is to be determined will be included in the
approved jurisdictional determination (AJD), which will be made available to the public on the District's website
and on the Headquarters USAGE website.
Disclosure: Submission of requested information is voluntary; however, if information is not provided, the
request for an AJD cannot be evaluated nor can an AJD be issued.
Version: May 2017 Page 6

Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: 5/22/2019
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: Ron Johnson, 1598 Mail Service Center, Raleigh, NC 27699-1598
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County/parish/borough: SUrry City: Thurmond
Center coordinates of site (lat/long in degree decimal format):
Lat.: 36.374633 Long.:-80.876551
Universal Transverse Mercator: 17
Name of nearest waterbody: South Fork Mitchell River
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):
TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site
number
Latitude
(decimal
degrees)
Longitude
(decimal
degrees)
Estimated amount
of aquatic resource
in review area
(acreage and linear
feet, if applicable)
Type of aquatic
resource (i.e., wetland
vs. non -wetland
waters)
Geographic authority
to which the aquatic
resource "may be"
subject (i.e., Section
404 or Section 10/404)
SA36.37377
-80.876611
21
Non -wetland Intermittent Stream
Section 404
SB36.373906
-80.876188
495
Non -wetland Perennial Stream
Section 404
SC
36.374633
-80.876551
756
Non -wetland Perennial Stream
Section 404
WA
36.375308
-80.876088
0.03
Wetland
Section 404

1) The Corps of Engineers believes that there may be jurisdictional aquatic resources in
the review area, and the requestor of this PJD is hereby advised of his or her option
to request and obtain an approved JD (AJD) for that review area based on an
informed decision after having discussed the various types of JDs and their
characteristics and circumstances when they may be appropriate.
2) In any circumstance where a permit applicant obtains an individual permit, or a
Nationwide General Permit (NWP) or other general permit verification requiring "pre -
construction notification" (PCN), or requests verification for a non -reporting NWP or
other general permit, and the permit applicant has not requested an AJD for the
activity, the permit applicant is hereby made aware that: (1) the permit applicant has
elected to seek a permit authorization based on a PJD, which does not make an
official determination of jurisdictional aquatic resources; (2) the applicant has the
option to request an AJD before accepting the terms and conditions of the permit
authorization, and that basing a permit authorization on an AJD could possibly result
in less compensatory mitigation being required or different special conditions; (3) the
applicant has the right to request an individual permit rather than accepting the terms
and conditions of the NWP or other general permit authorization; (4) the applicant can
accept a permit authorization and thereby agree to comply with all the terms and
conditions of that permit, including whatever mitigation requirements the Corps has
determined to be necessary; (5) undertaking any activity in reliance upon the subject
permit authorization without requesting an AJD constitutes the applicant's acceptance
of the use of the PJD; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Corps permit
authorization based on a PJD constitutes agreement that all aquatic resources in the
review area affected in any way by that activity will be treated as jurisdictional, and
waives any challenge to such jurisdiction in any administrative or judicial compliance
or enforcement action, or in any administrative appeal or in any Federal court; and (7)
whether the applicant elects to use either an AJD or a PJD, the JD will be processed
as soon as practicable. Further, an AJD, a proffered individual permit (and all terms
and conditions contained therein), or individual permit denial can be administratively
appealed pursuant to 33 C.F.R. Part 331. If, during an administrative appeal, it
becomes appropriate to make an official determination whether geographic
jurisdiction exists over aquatic resources in the review area, or to provide an official
delineation of jurisdictional aquatic resources in the review area, the Corps will
provide an AJD to accomplish that result, as soon as is practicable. This PJD finds
that there "may be"waters of the U.S. and/or that there "may be" navigable waters of
the U.S. on the subject review area, and identifies all aquatic features in the review
area that could be affected by the proposed activity, based on the following
information:

SUPPORTING DATA. Data reviewed for PJD (check all that apply)
Checked items should be included in subject file. Appropriately reference sources
below where indicated for all checked items:
❑■ Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map: Vicinity Map, Topo Map, Jurisdictional Features Map
Data sheets prepared/submitted by or on behalf of the PJD requestor.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report. Rationale:
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
❑■ U.S. Geological Survey map(s). Cite scale & quad name: 1:24,000 2016 Thurmond, NC; 2016 Roaring Gap, NC
Natural Resources Conservation Service Soil Survey. Citation: 2007 Surry County Soil Survey
❑ National wetlands inventory map(s). Cite name:
State/local wetland inventory map(s):
FEMA/FIRM maps:
❑ 100-year Floodplain Elevation is: .(National Geodetic Vertical Datum of 1929)
❑ Photographs: ❑ Aerial (Name & Date):
or ❑ Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily
been verified by the Corps and should not be relied upon for later jurisdictional
determinations.
Signature and date of
Regulatory staff member
completing PJD
Signature and date of
person requesting PJD
(REQUIRED, unless obtaining
the signature is impracticable)'
' Districts may establish timeframes for requestor to return signed PJD forms. If the requestor does not respond
within the established time frame, the district may presume concurrence and no additional follow up is
necessary prior to finalizing an action.

r ,
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER
GOVERNOR
Date:
MEMORANDUM TO
From:
SUBJECT:
JAws H. TROGDON, III
SECRETARY
August 12, 2019
File
Michelle Lopez, Transportation Planner, STV Engineers,
Inc.
NRCS Farmland Conversion Impact Rating Bridge No. 850318 on SR
1319 (Abe Mayes Road) over Unnamed Tributary (UT) of South Fork
Mitchell River
Surry County, NC
WBS 67123.1.1, STIP Project No. BR-0123
The Farmland Protection Policy Act of 1981 (7 CFR Part 658) (FPPA) requires an assessment of
the potential impacts of land acquisition and construction activities in prime, unique, and local or
statewide importance as defined by the US Natural Resource Conservation Service (MRCS). This
memo is to document the completion and results of the NRCS Farmland Conservation Impact
Rating process for Project BR-0123 consistent with FPPA.
Project Description
BR-0123 proposes to replace Bridge No. 850318 on SR 1319 (Abe Mayes Road) over
Unnamed Tributary (UT) of South Fork Mitchell River in Surry County.
Applicability
Project BR-0123 is subject to the provisions of FPPA for the following reasons:
• It is a federally funded project.
• It is not within a municipality, urbanized area, or urban built-up area
• Prime farmlands and farmlands of statewide importance are found within the project area
• The land is not in water storage or used for national defense purposes
Mailing Address: Telephone: [phone]
NC DEPARTMENT OF TRANSPORTATION Fax: [phone]
Project Development and Environmental Analysis Website: www.ncdot.gov
1000 Birch Ridge Drive
1548 Mail Service Center
Raleigh, NC 27699-1548

NRCS Farmland Figure
In accordance with guidance provided by NCDOT Community Studies, the farmland figure was
created to display the project location and a one -mile buffer over a layer displaying prime
farmland, farmland of statewide importance, and prime farmlands if drained located in the
vicinity of the project. A project footprint was created to include a 25-foot buffer from
estimated right of way. The NRCS farmland figure is attached to this memo.
Completion of Part VI of the NRCS Form AD-1006
Part VI (Site Assessment Criteria) of the NRCS Form AD-1006 was completed for this project.
Points allotted for each criterium and reasoning are provided below.
1. Area in Non -urban Use: 15 out of 15 points. Estimated using aerial
photography; approximately 100 percent of the land within the 1-mile buffer is
non -urban.
2. Perimeter in Non -urban Use: 10 out of 10 points. Estimated using aerial
photography; approximately 100 percent borders on land in non -urban use.
3. Percent of Site Being Farmed: 1 out of 20 points. Estimated using aerial photography,
approximately 5 percent of the project footprint site is being farmed.
4. Protection Provided by State and Local Government: 3 out of 20 points. A small
portion of the project footprint site is designated as a Voluntary Agriculture
District (VAD), but minimal impacts are anticipated.
5. Distance from Urban Built-up Area: 15 out of 15 points. Determined using aerial
photography; residential development is not within 10,560 feet of the project site.
6. Distance to Urban Support Services: 10 out of 15 points. County water and sewer
maps indicate services exist within'/z mile of the site. Some support services exist
within 3 miles of the project footprint site.
7. Size of Present Farm Unit Compared to Average: 2 out of 10 points. The farm unit is
more than 60 percent below the average size farm unit in Surry County (101 acres).
8. Creation of Non-farmable Farmland: 0 out of 10 points. The project will have
minimal implications on remaining farmable land.
9. Availability of Farm Support Services: 0 out of 5 points. No required services are
available in the project footprint site.
10. On -Farm Investments: 2 out of 20 points. Some on -farm investments including
waterways were identified using aerial imagery in the project footprint site.
11. Effects of Conversion on Farm Support Services: 0 out of 10 points. No significant
reduction in demand for support services is expected to result from the project.
12. Compatibility with Existing Agricultural Use: 0 out of 10 points. The project is
compatible with existing agricultural use.
Result of Site Assessment Criteria
The sum of the points assigned in part VI of the NRCS for AD-1006 for BR-0123 is 58.
Summary
A preliminary screening of farmland conversion impacts in the project area has been completed and
a total score of 58 out of 160 points was calculated for the BR-0123 project site. Since the total site
assessment score does not exceed the 60-point threshold established by NRCS, farmland conversion
impacts may be anticipated, but are not considered notable.

Sources
US Census. Census of Agriculture. 2012. County Data. North Carolina. Surry County. Accessed
6/25/2019.
(hqps://www.nass.usda.gov/Publications/AgCensus/2012/Online Resources/CojDjy Profiles/North_Carolina/cp37171.pdf)
Surry County. GIS and Mapping. www.gis.surryinfo.net. Accessed 6/25/2019.
(www.gis.sun-vinfo.net)
Legal Information Institute. Section 658.5- Criteria. Accessed 6/3/2019.
(hqps://www.law.comell.edu/cfr/text/7/658.5)
Attachments
NRCS Farmland figure
Cc: Harrison Marshall and Herman Huang, NCDOT Community Studies
jo

11
DI
kk) 1
0 750 1,500 3,000
Feet
i
BR-0123
Legend Surr County , NC
o� 1lolarN c Y tY- Bridge No. 318
a 49 Bridge No. Farmland of Replacement Project
ti 318 over UT local over UT of South Fork
* of S. Fork importance �'
o Mitchell River Farmland of Mitchell River
o sz Project W statewide Surry County
fls ID Footprint importance 601 NCDOT Division 11
OFTRA�N � 01-mile Buffer Prime July 2019
— Roads farmland if
Parcels drained
['trTl ZQ Streams NRCS Farmland Figure
V\ r r'rfrl' All areas are Sources: Sorry County GIs Department,
prime USDA/NRCS Soil Survey Center,
farmland NC One Map & Google Earth

Demographic Memorandum
Bridge No. 318
Abe Mayes Road) over Unnamed Tributary to the South Fork Mitchell River
Surry County, North Carolina
NCDOT Division 11
STIP Project BR-0123
In order to evaluate whether there are Environmental Justice (EJ) or Limited English Proficiency (LEP) populations in the
vicinity of STIP Project BR-0123, the 2019 NCDOT Demographic Tool was used. A Direct Community Impact Area (DCIA)
had been developed for the project, and in accordance with NCDOT guidance, the US Census Block Groups that encompass
the DCIA make up the Demographic Study Area (DSA). The DSA is the analysis area used in this memorandum. Census
Tract 9308.02, Block Group 1 make up the DSA.
Environmental Justice
Minority populations include all races that are non-White, and include Hispanic populations that are White. Two NCDOT
thresholds are used to identify the presence of minority populations. These thresholds are any Block Group where 50% or
more of the population is minority (or a majority minority), or any Block Group with a minority population at least 10
percentage points higher than the county average.
As shown in Table 1, none of the Block Groups in the DSA exceed the thresholds for an EJ population.
Table 1: Minority Population
White, Non -Hispanic
Minority Population*
Meets Thresholds
Geography y
9
Total
Population
°
10 /°
#
%
#
%
50%
over
County
CT 9308.02, BG 1
731
702
96.0%
29
4.0%
No
No
DSA
731
702
96.0%
29
4.0%
No
N/A
Surry County
72,315
61,034
84.4%
11,281
15.6%
* Minority population includes all races that are Non -White and Hispanic populations that are also White.
Source: US Census Bureau, American Community Survey 5-year Estimates (2013-2017), Table B03002,
"Hispanic or Latino Origin by Race."
NCDOT uses poverty as an indicator of low-income. Two NCDOT thresholds are used to identify the presence of low-
income populations. These thresholds are any Block Group where the percentage of the population in any of the poverty
categories — Below Poverty Level, Very Poor or Near Poor equals or exceeds 25% of the total population of the Block
Group, or any Block Group where the percentage of the population in any of the poverty categories exceeds the county
average by five percentage points or more.
As shown in Table 2, none of the Block Groups exceed the NCDOT poverty thresholds.
5/28/2019 STIP PROJECT BR-0123
DEMOGRAPHIC MEMORANDUM

Table 2: Poverty Status
Population
Below Poverty
Under 50% of
Between 100%and 149% of
Meets
for whom
Level
Poverty Level
poverty Level
Thresholds
Geography
Poverty
Status is
5%
Determined
#
%
#
%
#
%
25%
over
County
CT 9308.02, BG 1
731
103
14.1%
41
5.6%
99
13.5%
No
No
DSA
731
103
14.1%
41
5.6%
99
13.5%
No
I N/A
Surry County
71,283
12,534
17.6%
5,790
8.1%
10,962
15.4%
Source: US Census Bureau, American Community Survey 5-year Estimates (2013-2017), Table C17002,
"Ratio of Income to Poverty Level in the Past 12 Months."
Census data does not indicate a notable presence of populations meeting the criteria for Environmental Justice within
the Demographic Study Area (DSA), nor were minority, low-income, or non-EJ Title VI communities observed within the
Direct Community Impact Area (DCIA) during the field visit and were not noted by local planners.
Limited English-speaking Populations (LEP)
The US Department of Justice Safe Harbor threshold for LEP is met when there is a language group that speaks English
less than very well and that either has 1,000 adults or makes up 5% of the aggregate DSA population (with at least 50
adults). NCDOT's threshold for language assistance is more than 50 adults of a Block Group's population within a language
group who speaks English less than very well.
As shown in Table 3, the US Department of Justice Safe Harbor threshold for LEP and NCDOT's language assistance
threshold are not met.
Table 3: Limited English Proficiency
Primary Language Group of Persons Who Speak English Less
Total Adult
than Very Well
Meets
Geography
Population,
18 years and
Thresholds
Spanish
Other Indo-
Euro
Asian/Pacific
Other
older
#
%
#
%
#
%
#
%
LEP
LA
CT 9308.02, BG 1
622
-
0.0%
0.0%
-
0.0%
-
0.0%
N/A
No
DSA
622
-
0.0%
-
0.0%
-
0.0%
-
0.0%
No
N/A
Source: US Census Bureau, American Community Survey 5-year Estimates (2013-2017), Table B16004, "Age
by Language Spoken at Home by Ability to Speak English for the Population 5 Years and Over."
Census data does not indicate Limited English Proficiency (LEP) populations meeting the US Department of Justice LEP
Safe Harbor threshold or a notable presence within the Demographic Study Area.
5/28/2019 STIP PROJECT BR-0123
DEMOGRAPHIC MEMORANDUM

N
.. ... ..
20
s
�O
�� YSTPGK ROPD
NP
ALLEGHANY
COUNTY
I
WILKES COUNTY
Legend
p CIA
Project Study Area
Parcel
CT 9308.02, BG 1
STV ' - ip0
S,Q
7,_Q
O
J
2
k
O
X
G)
��EN RoPD Go
0 2,500 5,000 10,000
Feet
BR-0123
Surry County, NC Bridge No. 318
Replacement Project
over UT of South Fork
Mitchell River
e2 Sorry County
so, NCDOT Division 11
May 2019
Demographic
Memo Map
Sources: Sorry County GIS Department,
NC One Map & Google Earth

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER
GOVERNOR
July 19, 2018
Secretary Elaine Chao
U.S. Department of Transportation
1200 New Jersey Avenue, SE
Washington, DC, 20590
JAME5 H. TROGDON, III
SECRETARY
Subject: Certification of Financial Contribution BUILD Grant Application: Growing
Rural Economy and Agriculture through Transportation & Technology
Enhancement or Replacement in North Carolina (GREATTER-NC) Project
Dear Secretary Chao:
The North Carolina Department of Transportation wishes to express its full support for
the Growing Rural Economy and Agriculture through Transportation & Technology
Enhancement or Replacement in North Carolina Project (GREATTER-NC) project under
the United States Department of Transportation's 2018 Better Utilizing Investments to
Leverage Development (BUILD) program. This project represents much -needed
infrastructure and technology improvements to several economically depressed rural
counties in eastern and western North Carolina, as reflected in our mission statement:
"Connecting people, products and places safely and efficiently with
customer focus, accountability and environmental sensitivity to enhance
the economy and vitality of North Carolina. "
As demonstrated in the project narrative and letters of support, the project will
reconstruct seventy-seven (77) rural bridges located in 17 of the most rural and
economically depressed counties across the state, potentially adding broadband capability
to a. number of the structures as they are rebuilt. In addition, nineteen (19) of these
bridges include weight restrictions that result in large or heavy vehicles having to detour
to avoid crossing them. The GREATTER-NC Project directly addresses the dual
challenge of improving physical and digital connectivity in North Carolina's rural
communities while providing additional safety improvements, reducing travel times and
improving freight connectivity and rural communications infrastructure.
,fading Address:
NC DEPARTMENT OF TRANSPORTATION
FINANCIAL MANAGEMENT DIVISION
1514 MAIL SERVICE CENTER
RALEIGH, NC 27699
Telephone: [phone]
Fax: [phone]
Cusronrer Service: 1-877-368-4968
JV sile: www.nedot.gov
Location:
1 SOUTH WILMINGTON STREET
RALEIGH, NC 27601

Secretary Elaine Chao
Page 2 of 2
July 19, 2018
To that end, the NCDOT will fund the GREATTER-NC project in the amount of at. least
$94,100,000 towards a successful BUILD grant from the state funded North Carolina
Highway Trust Fund.
Thank you for your consideration of the GREATTER-NC for the 2018 BUILD
Discretionary Grant Program. If NCDQT can be of any further assistance, please do not
hesitate to contact me at [phone] or via e-mail at erodewald(@ncdot.gov.
Sincerely,
L 4m
Evan Rodewald
Chief Financial Officer

5/11/12
NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
FIELD SCOPING MEETING WORKSHEET
Return with Comments to Division by (Two weeks prior to FSM)
TIP No.: BR-0123 FIELD REVIEW MEETING DATE: 04/17/2019
DIVISION: 11 LOCATION: 36.37468,-80.87657
COUNTY: Surry
ROUTE (US / NC / SR): SR 1319
PROJECT DESCRIPTION: Replace Bridge No. 850318 over UT to South Fork Mitchell River
FUNCTIONAL CLASSIFICATION: Local
TIER: Sub- Reigonal
MPO / RPO AREA:
MUNICIPALITY:
ATTENDEES NAME (PRINT) PHONE No E-MAIL
DIVISION CONSTRUCTION ENGINEER
DIVISION BRIDGE MAINTENANCE
ENGINEER
David Wayne
DIVISION BRIDGE PROGRAM
MANAGER
Joe Laws
UTILITY COORDINATOR
Sunil Singh
DIVISION ENVIRONMENTAL OFFICER
Kevin Hining / Heath
Slaughter
DIVISION RIGHT OF WAY
REPRESENTATIVE
HYDRAULICS REPRESENTATIVE
PDEA REPRESENTATIVE
NEU REPRESENTATIVE
GEOTECHNICAL REPRESENTATIVE
Shiping Yang
STRUCTURE DESIGN
REPRESENTATIVE
ROADWAY DESIGN REPRESENTATIVE
LOCATION AND SURVEYS
REPRESENTATIVE
WORK ZONE TRAFFIC CONTROL
REPRESENTATIVE
STV Attendees: Kevin Bailey, Shirshant Sharma, Brandon Phillips, Laura Braunteld, Michelle Lopez
1

5/11/12
DIVISION (COMPLETED BY DIVISION STAFF AND SENT WITH THE FSM LETTER)
EXISTING FEATURES
FEATURE BRIDGED: UT to South Fork Mitchell River
(BRIDGE / CULVERT) LENGTH 26 (FT.) DECK WIDTH (OUT TO OUT) 21 (FT.)
WATER DEPTH: 0.3 (FT.) HEIGHT BED -TO -CROWN: 20 (FT.)
PRIOR SURVEY DATE: POSTED: SV TTST:
STRUCTURE TYPE: Timber Deck On I -beams
SPAN TYPE: Timber Deck
SUFFICIENCY RATING: 84.86
POSTED SPEED LIMIT IN PROJECT VICINITY: Gravel Road (MPH / STATUTORY 55MPH)
DETOUR: OFF -SITE YES ON -SITE NO STAGE CONSTRUCTION NO
IF DETOUR IS OFF -SITE, PROVIDE DESCRIPTION OF DETOUR ROUTE SR 1320, SR 1301, and Oscar Callaway
Road
APPROXIMATE LENGTH OF DETOUR? 2.8 ( MILES )
IMPROVEMENTS NEEDED TO ROAD ON DETOUR? No
IMPROVEMENTS NEEDED TO BRIDGES ON DETOUR? No
ARE BRIDGES ON DETOUR CURRENTLY PROGRAMMED ON TIP? NO COMMENTS:
ARE THERE EMS, SCHOOL, OR BUSINESS ACCESS ISSUES? NO COMMENTS:
ARE THERE ANY RAILROAD CROSSINGS ON DETOUR? NO COMMENTS:
SHOULD WORK ZONE PEDESTRIAN ACCESS BE MAINTAINED DURING CONSTRUCTION? NO
REASONS:
IMPACT RATING TO UTILITIES LOW
OVERHEAD UTILITY LINES NO IN CONFLICT NO
POWER TRANSMISSION LINES NO IN CONFLICT NO
TELEPHONE / CABLE LINES NO IN CONFLICT NO
FIBER OPTIC NO IN CONFLICT NO
WATER NO IN CONFLICT NO
SEWER NO IN CONFLCIT NO
NATURAL GAS NO IN CONFLICT NO
OTHER N/A IN CONFLICT N/A
BASED ON THE PAST HISTORY NEAR THIS PROJECT SITE, WHAT IS THE ESTIMATED TIME REQUIRED TO
COMPLETE UTILITY ADJUSTMENTS 4-5 MONTHS
IS THERE ANY FUTURE UTILITY CONSTRUCTION ANTICIPATED IN THE PROJECT AREA Future Fiber
IS A FEMA BUY-OUT PROPERTY BEING IMPACTED NO
Pi

5/11/12
HYDRAULICS UNIT (COMPLETED BY HYDRAULICS UNIT STAFF PRIOR TO THE FSM)
WILL THIS PROJECT REQUIRE A FEMA PERMIT? YES
IS THERE UNUSUAL SCOUR POTENTIAL? NO IS PROTECTION NEEDED? YES
ARE BANKS STABLE? No (outside of bridge) IS PROTECTION NEEDED? Yes (within ROW)
DOES STREAM CARRY APPRECIABLE AMOUNT OF LARGE DEBRIS? No
WILL THE PLACEMENT OF BENTS IN THE WATER BE ALLOWED N/A COMMENTS
WERE HYDRAULIC ALTERNATIVES BESIDES A BRIDGE CONSIDERED No COMMENTS
POSSIBLE SPAN LAYOUT: 40 FT (max.), maybe 35 FT
GEUTECHNICAL UNIT (COMPLETED BY GEOTECHNICAL UNIT PRIOR TO THE FSM)
EXISTING FOUNDATION REPORTS? No IF SO, ATTACH.
KNOWN GEOLOGICAL FEATURES IN AREA WHICH MAY AFFECT DESIGN No
ARE PERMITS NEEDED FOR INVESTIGATIVE WORK AT SITE No COMMENTS:
ARE THERE ANY HISTORICAL AND / OR VIBRATION SENSITIVE STRUCTURES NEAR BY No COMMENTS:
ARE THERE ANY KNOWN LANDFILLS AND / OR GEOENVIRONMENTAL HAZARD SITES AT OR WITHIN CLOSE
PROXIMITY TO THE PROJECT SITE No COMMENTS: verify with Cyrus Parker
DEPTH OF WEATHERED ROCK OR ROCK BELOW STREAMBED 0 (FT.) — Exposed rock, existing footings on rock
ARE ANY IMPACTS ANTCIPATED TO NATURAL SPRINGS OR ARTESIAN WELLS No COMMENTS:
POSSIBLE FOUNDATION TYPE: Vertical Abutments on spread footings
3

5/11/12
PD & EA AND NEU UNIT (COMPLETED BY PDEA STAFF PRIOR TO THE FSM)
TRAFFIC FORECAST (AS PREPARED BY TRANSPORTATION PLANNING BRANCH AND PROVIDED BY PDEA)
Accident History:
-L- BASE YEAR (2015) ANNUAL AVERAGE DAILY TRAFFIC 290 % TRUCKS/DUALS
-L- DESIGN YEAR (20 ) ANNUAL AVERAGE DAILY TRAFFIC % TRUCKS/DUALS
SHOW -Y-LINE TRAFFIC IF APPLICABLE FOR BRIDGES OVER / UNDER.
-Y- BASE YEAR (20 ) ANNUAL AVERAGE DAILY TRAFFIC % TRUCKS/DUALS
-Y- DESIGN YEAR (20 ) ANNUAL AVERAGE DAILY TRAFFIC % TRUCKS/DUALS
TRAFFIC SAFETY (AS PREPARED BY THE TRAFFIC SAFETY UNIT AND PROVIDED BY PDEA)
OPERATING SPEED: 25 MPH (Per speed study)
CRASH RATE:
WETLANDS AT SITE Yes COMMENTS: One wetland, Wetland WA, delineated during field work within the project study
area.
KNOWN ENDANGERED SPECIES POPULATIONS IN AREA Yes COMMENTS: NCNHP database showed one current
occurrence of a Federally endangered species within 1 mile of proposed project:Bog Turtle (EOID 11892 Observed 1997
TROUT OR TVA COUNTY Yes COMMENTS: Within USACE Trout Watershed; No WRC Trout Waters Win 1 mi.
downstream
CAMA COUNTY No PRIMARY NURSERY AREA No
MORATORIA No IF YES -DURATION
COMMENTS:
IS WATER FEATURE CLASSIFIED AS A WILD AND SCENIC RIVER No COMMENTS:
WHAT IS THE WATER QUALITY CLASSIFICATION FOR THIS PROJECT: C: UT South Fork Mitchell River
WILL A COAST GUARD PERMIT BE REQUIRED No COMMENTS:
IS THE PROJECT SITE IN OR NEAR ANY OF THE FOLLOWING:
NATIONAL FOREST No
WILDLIFE REFUGE No
STATE, COUNTY, OR LOCAL PARK No
AIRPORT No
A LAKE FOR RECREATION OR POWER GENERATION No
WATER SUPPLY RESERVOIR No
NUTRIENT SENSITIVE WATERS No
PUBLIC USE BOAT RAMP No
CEMETARIES No
WILL A FEDERAL ENERGY REGULATORY COMMISSION PERMIT BE REQUIRED No
IS THE PROJECT AREA KNOWN FOR POTENTIAL INDIAN, COLONIAL, OR OTHER ARCHAEOLOGICAL SITES
Yes
KNOWN OR POTENTIAL HISTORIC PROPERTIES IN THE AREA No
IS THE BRIDGE STRUCTURE ITSELF, OR ANY PART THEREOF, CONSIDERED HISTORIC No
WILL THE PROJECT IMPACT A CHURCH, COMMUNITY CENTER, OR OTHER PUBLIC FACILITY No
IS THIS PROJECT ON A STATEWIDE BICYCLE ROUTE OR A LOCAL NON -MARKED BICYCLE ROUTE None
4

5/11/12
ANY CLARIFICATION OR COMMENTS ON ITEMS ABOVE: Archaeology Survey Required
ROADWAY DESIGN UNIT (COMPLETED BY ROADWAY DESIGN UNIT PRIOR TO FSM)
ALIGNMENT: EXISTING HORIZONTAL Poor
EXISTING VERTICAL Fair
POSSIBLE DESIGN STANDARDS Subregional Tier
POSSIBLE DESIGN SPEED 25 (MPH)
POSSIBLE DESIGN EXCEPTIONS Possibly COMMENT
APPROXIMATE PROJECT LENGTH 750 (FT) NUMBER AND WIDTH OF LANES 2/ 10 ft
SHOULD THIS PROJECT HAVE CURB AND GUTTER OR SHOULDER APPROACHES Shoulders
COMMENT
TOTAL SHOULDER WIDTH 3 (FT) PAVED SHOULDER WIDTH 0 (FT)
CLEAR ROADWAY ON STRUCTURE 27 (FT)
WILL EXISTING DRIVEWAYS, BUSINESS ACCESS, -Y- LINES OR RAMPS NEED TO BE RELOCATED No
COMMENTS:
IS THERE ADDITIONAL RIGHT OF WAY / PERMANENT EASEMENTS / TEMPORARY EASEMENTS ANTICIPATED FOR
CONSTRUCTION Yes COMMENT
ARE ANY RETAINING WALLS ANTICIPATED No
IS THERE A POSSIBILITY OF RELOCATEES No IF SO, DESCRIBE
ADDITIONAL COMMENTS: hold upstream edge and widen to downstream side
STRUCTURE DESIGN UNIT (COMPLETED BY THE STRUCTURE DESIGN UNIT PRIOR TO THE FSM)
POSSIBLE SUPERSTRUCTURE:
TYPE: 21" Cored Slab
NUMBER OF SPANS 1 LENGTH OF SPANS 35 or 40 (FT)
WILL RAILROAD INVOLVEMENT BE REQUIRED No
WILL STRUCTURE REQUIRE DESIGN FOR VESSEL IMPACT OR FENDER SYSTEM No
DESCRIPTION:
ARE ANY RETAINING WALLS ANTICIPATED No
5

5/11/12
CONSTRUCTABILITY AND ACCESS (DISCUSSED AT THE FSM BY DIVISION BRIDGE MANAGER)
METHOD OF ACCESS: Road closure, Off -site detour
TOP -DOWN Yes
(WORK BRIDGE / CAUSEWAY) PROPOSED LOCATION RELATIVE TO EXISTING STRUCTURE: N/A
PROPOSED LENGTH (FT) WIDTH (FT)
MATERIAL AND EQUIPMENT ACCESS TO SITE:
TRACTOR -TRAILER ACCESS Yes BARGE ACCESS No HEAVY EQUIPMENT ACCESS Yes
POSTED ROADS AND POSTED BRIDGES IN VICINITY THAT MAY AFFECT ACCESS No
ARE CONSTRUCTION STAGING AREAS AVAILABLE NEAR SITE Yes
ANY ANTICIPATED AREAS OF TEMPORARY SHORING REQUIRED No
ADDITIONAL COMMENTS:
ITEMS TO BE DISCUSSED / RESOLVED AT FSM BY ATTENDEES
LIST ALTERNATIVES TO BE STUDIED BY ROADWAY DESIGN:
1) anticipate vertical abutments with waived setbacks (verify with Hydraulics Unit)
2) widening should be to downstream side
3) utilize full super (0.02) on bridge to downstream side
4) hold End Bent at T-intersection end
5) cutoff existing abutment and leave lower sections
6) ConSpan alternate discussed
7) Bottomless RCBC discussed
DESCRIBE ANY DISCUSSION REGARDING HOW THE ALTERNATIVES WERE DECIDED UPON, WHY CERTAIN
ALTERANTIVES WERE REJECTED, AND IF AN ALTERNATIVE WAS SELECTED, WHY.
ConSpan alternate probably not a good solution due to limited height above stream to roadway surface
CHECK ONE
TYPE OF ENVIRONMENTAL DOCUMENT (CHECK ONE)
CATIGORICAL EXCLUSION (CE)
PROGRAMMATIC CATIGORICAL EXCLUSION (PCE) ❑
THE OPTIMUM LET DATE FOR THIS PROJECT IS: Spring/Summer 2020
ADDITIONAL COMMENTS AND/OR UNRESOLVED ISSUES TO BE ADDRESSED: Hydraulics to confirm bottomless
RCBC use
6

of aaprr, c NC DEPARTMENT OF TRANSPORTATION ATTENTION: DATA CHANGES
h, DIVISION OF HIGHWAYS
STRUCTURE MANAGEMENT UNIT
e
e
OF t
Structure Safety Report
Routine Element Inspection - Contract
INSPECTION DATE: 12/13/2017
DIVISION: 11 COUNTY: SURRY STRUCTURE NUMBER: 850318
FACILITY CARRIED: SR1319
LOCATION: 40 FT.W.JCT.SR1318
FEATURE INTERSECTED: UT TO S.FORK MICHELL RVR.
LATITUDE: 36' 22' 28.85" LONGITUDE: 80' 52' 35.68"
SUPERSTRUCTURE: TIMBER FLOOR ON [-BEAMS
SUBSTRUCTURE: ABUTMENTS:REINFORCED CONCRETE
SPANS: 1 SPAN. SEE SPAN PROFILE SHEET FOR SPAN DETAILS
FREQUENCY: 24 MONTHS
MILE POST:
❑FRACTURE CRITICAL
❑TEMPORARY SHORING
❑SCOUR CRITICAL
❑SCOUR PLAN OF ACTION
GRADES: DECK 7
SUPERSTRUCTURE 7
SUBSTRUCTURE 6
CULVERT N
POSTED SV: 23
OTHER SIGNS PRESENT: FOUR (4) DELINEATORS
LOOKING EAST
POSTED TTST: 31
Sign noticed
Number
issued for
Required
NO
WEIGHT LIMIT
0
NO
DELINEATORS
0
NO
NARROW BRIDGE
0
NO
ONE LANE BRIDGE
0
NO
LOW CLEARANCE
0
DIRECTION OF
INSPECTION
DIRECTION
MATCHES PLANS
INSPECTED BY SIGNATURE ASSISTED BY K. Mobley
D. Curtis C t-�,
IAi-P

Structure Element Scoring
Structure Number: 850318
Inspection Date 12/13/201
7
Element
Number
Parent
Number
Element Name
Location
Total
Quantity
Level
Quantity
Level
Quantity
Level
Quantity
Level
Quantity
31
0
Timber Deck
Deck
553
553
0
0
0
107
0
Steel Open Girder/Beam
Beam
300
300
0
0
0
515
107
Steel Protective Coating
Beam
1056
1056
0
0
0
215
0
Reinforced Concrete Abutment
Abutments
84
81
1
2
0
220
0
Reinforced Concrete Pile Cap/Footing
Footing
84
41
29
14
0
316
0
Other Bearings
Bearing Device
24
0
24
0
0
515
316
Steel Protective Coating
Bearing Device
24
0
24
0
0
332
0
Timber Bridge Railing
Bridge Rail
54
21
33
0
0
510
10
lWearing Surface
lWearing Surfaces
1527
1523
10
14
10

Summary of Maintenance Needs
Maintenance By Defect
Structure Number: 850318
Inspection Date: 12/13/2017
MMS
Code
Element Name
Defect Name
Recommended Quantity
71
3350
Reinforced Concrete Abutment
Cracking (RC and Other)
2 Feet
3350
Reinforced Concrete Abutment
Delamination/Spall
1 Feet
3348
Reinforced Concrete Pile Cap/Footing
Abrasion/Wear (PSC/RC)
14 Feet
2816
Wearing Surface
Crack (Wearing Surface)
4 Square Feet
3342
Steel Protective Coating
Effectiveness (Steel Protective Coatings)
24 Square Feet

Element Structure Maintenance Quantities
Structure Number: 850318
Inspection Date 12/13/2017
Location
MMS
Code
Description
Maint
Quantity
Total
Quantity
Severe
Quantity
Poor
Quantity
Fair
Quantity
Good
Quantity
Abutments
3350
Maintenance of Concrete Wings and Wall
3
84
0
2
1
81
Beam
3314
Maintenance Steel Superstructure Components
0
300
0
0
0
300
Beam
3342
Clean and Paint Steel
0
1056
0
0
0
1056
Bearing Device
3334
Bridge Bearing
0
24
0
0
24
0
Bearing Device
3342
Clean and Paint Steel
24
24
0
0
24
0
Bridge Rail
3316
Maintenance of Timber Bridge Rail
0
54
0
0
33
21
Deck
3324
Maintenance of Timber Deck Components
0
553
0
0
0
553
Footing
3348
Maintenance of Concrete Substructure
14
84
0
14
29
41
Baring Surfaces
2816
Asphalt Surface Repair
4
527
0
4
0
523

Element Condition and Maintenance Data
Structure Number: 850318
Span 1
Asphalt Wearing Surface
Element
Number Element Name
510 Wearing Surface
Wearing Surface
Inspection Date: 12/13/2017
Total
CS1
CS2
CS3
CS4
Qty
Qty
Qty
Qty
Qty
527
523
0
4
0 Square Feet
Number ueieUL i ype veieci vescnpuon w w Uiy Qty
510 Crack (Wearing 48" LONG X UP TO 1/4" X FULL DEPTH TRANSVERSE 3 4 4 Square Feet
Surface) REFLECTIVE CRACK IN LEFT SHOULDER,
APPROXIMATELY 3' FROM ABUTMENT 1 (SEE PHOTO)
General Comments
Span 1 Left Bridge Rail
Timber Rail
Element Total CS1 CS2 CS3 CS4
Number Element Name Qty Qty Qty Qty Qty
332 Timber Bridge Railing 27 0 27 0 0 Feet
Element Maint
Number Defect Type Defect Description CS CS Qty Qty
332 Check/Shake UP TO 1/16" CHECKS THROUGHOUT SPACERS 2 Feet
332 Check/Shake UP TO 1/8" X 1/2" DEEP CHECKS THROUGHOUT TOP 2 27 Feet
BOARD, CHECKS APPROXIMATELY 4' FROM ABUTMENT 2
SHOWN IN PHOTO
General Comments
Span 1 Right Bridge Rail
Timber Rail
Element
Total
CS1
CS2
CS3
CS4
Number Element Name
Qty
Qty
Qty
Qty
Qty
332 Timber Bridge Railing
27
21
6
0
0
Feet
Element
Maint
Number Defect Type Defect Description
CS
CS Qty
Qty
332 Check/Shake UP TO 1/16" CHECKS THROUGHOUT SPACERS, CHECKS
2
6
Feet
IN SPACER AT POST 5 SHOWN IN PHOTO
General Comments
Span 1 Near Bearing
Other Bearing
Element
Total
CS1
CS2
CS3
CS4
Number Element Name
Qty
Qty
Qty
Qty
Qty
316 Other Bearings
1
0
1
0
0
Each
515 Steel Protective Coating
1
0
1
0
0
Square Feet
Element
Maint
Number Defect Type Defect Description
CS
CS Qty
Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 1 BEARING
2
1
Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT
BEAM 1
2
1
1 Square Feet
Protective Coatings) BEARING
General Comments

Structure Number: 850318
Span 1
Other Bearing
Element
Number Element Name
316 Other Bearings
515 Steel Protective Coating
Far Bearing
Inspection Date: 12/13/2017
Total
CS1
CS2
CS3
CS4
Qty
Qty
Qty
Qty
Qty
1
0
1
0
0 Each
1
0
1
0
0 Square Feet
Element Maint
Number Defect Type Defect Description CS CS Qty Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 1 BEARING 2 1 Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 1 2 1 1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1 Near Bearing
Other Bearing
Element Total CS1
CS2
CS3
CS4
Number Element Name Qty Qty
Qty
Qty
Qty
316 Other Bearings 1 0
1
0
0
Each
515 Steel Protective Coating 1 0
1
0
0
Square Feet
Element
Maint
Number Defect Type Defect Description
CS
CS Qty
Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 2 BEARING
2
1
Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 2
2
1
1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1 Far Bearing
Other Bearing
Element Total CS1
CS2
CS3
CS4
Number Element Name Qty Qty
Qty
Qty
Qty
316 Other Bearings 1 0
1
0
0
Each
515 Steel Protective Coating 1 0
1
0
0
Square Feet
Element
Maint
Number Defect Type Defect Description
CS
CS Qty
Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 2 BEARING
2
1
Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 2
2
1
1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1 Near Bearing
Other Bearing
Element Total CS1
CS2
CS3
CS4
Number Element Name Qty Qty
Qty
Qty
Qty
316 Other Bearings 1 0
1
0
0
Each
515 Steel Protective Coating 1 0
1
0
0
Square Feet
Element
Maint
Number Defect Type Defect Description
CS
CS Qty
Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 3 BEARING
2
1
Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 3
2
1
1 Square Feet
Protective Coatings) BEARING

Structure Number: 850318
General Comments
Span 1
Other Bearing
Element
Number
316
515
Element Name
Other Bearings
Steel Protective Coating
Far Bearing
Inspection Date: 12/13/2017
Total
CS1
CS2
CS3
CS4
Qty
Qty
Qty
Qty
Qty
1
0
1
0
0 Each
1
0
1
0
0 Square Feet
Number �VIUUL I yNU �UIUUL �U�UI INLIUII �Q �Q WLy Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 3 BEARING 2 1 Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 3 2 1 1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1
Other Bearing
Element
Number
316
515
Element Name
Other Bearings
Steel Protective Coating
Near Bearing
Total
CS1
CS2
CS3
CS4
Qty
Qty
Qty
Qty
Qty
1
0
1
0
0 Each
1
0
1
0
0 Square Feet
Number vc .— i ypc vci--11Nuv11 .«y Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 4 BEARING 2 1 Each
(SEE PHOTO)
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 4 2 1 1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1
Other Bearing
Element
Number
316
515
Element Name
Other Bearings
Steel Protective Coating
Far Bearing
Total
CS1
CS2
CS3
CS4
Qty
Qty
Qty
Qty
Qty
1
0
1
0
0 Each
1
0
1
0
0 Square Feet
Number u.,— i yNc --1 uw iNuvii w,y Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 4 BEARING 2 1 Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 4 2 1 1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1
Other Bearing
Element
Number
316
515
Element Name
Other Bearings
Steel Protective Coating
Near Bearing
Total
CS1
CS2
CS3
CS4
Qty
Qty
Qty
Qty
Qty
1
0
1
0
0 Each
1
0
1
0
0 Square Feet
Element Maint
Number Defect Type Defect Description CS CS Qty Qty

Structure Number: 850318
Inspection Date: 12/13/2017
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 5 BEARING
2
1
Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 5
2
1
1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1 Far Bearing
Other Bearing
Element Total CS1
CS2
CS3
CS4
Number Element Name Qty Qty
Qty
Qty
Qty
316 Other Bearings 1 0
1
0
0
Each
515 Steel Protective Coating 1 0
1
0
0
Square Feet
Element
Maint
Number Defect Type Defect Description
CS
CS Qty
Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 5 BEARING
2
1
Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 5
2
1
1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1 Near Bearing
Other Bearing
Element Total CS1
CS2
CS3
CS4
Number Element Name Qty Qty
Qty
Qty
Qty
316 Other Bearings 1 0
1
0
0
Each
515 Steel Protective Coating 1 0
1
0
0
Square Feet
Element
Maint
Number Defect Type Defect Description
CS
CS Qty
Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 6 BEARING
2
1
Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 6
2
1
1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1 Far Bearing
Other Bearing
Element Total CS1
CS2
CS3
CS4
Number Element Name Qty Qty
Qty
Qty
Qty
316 Other Bearings 1 0
1
0
0
Each
515 Steel Protective Coating 1 0
1
0
0
Square Feet
Element
Maint
Number Defect Type Defect Description
CS
CS Qty
Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 6 BEARING
2
1
Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 6
2
1
1 Square Feet
Protective Coatings) BEARING
General Comments

Structure Number: 850318
Span 1
Other Bearing
Element
Number Element Name
316 Other Bearings
515 Steel Protective Coating
Near Bearing
Inspection Date: 12/13/2017
Total
CS1
CS2
CS3
CS4
Qty
Qty
Qty
Qty
Qty
1
0
1
0
0 Each
1
0
1
0
0 Square Feet
Element Maint
Number Defect Type Defect Description CS CS Qty Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 7 BEARING 2 1 Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 7 2 1 1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1 Far Bearing
Other Bearing
Element Total CS1
CS2
CS3
CS4
Number Element Name Qty Qty
Qty
Qty
Qty
316 Other Bearings 1 0
1
0
0
Each
515 Steel Protective Coating 1 0
1
0
0
Square Feet
Element
Maint
Number Defect Type Defect Description
CS
CS Qty
Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 7 BEARING
2
1
Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 7
2
1
1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1 Near Bearing
Other Bearing
Element Total CS1
CS2
CS3
CS4
Number Element Name Qty Qty
Qty
Qty
Qty
316 Other Bearings 1 0
1
0
0
Each
515 Steel Protective Coating 1 0
1
0
0
Square Feet
Element
Maint
Number Defect Type Defect Description
CS
CS Qty
Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 8 BEARING
2
1
Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 8
2
1
1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1 Far Bearing
Other Bearing
Element Total CS1
CS2
CS3
CS4
Number Element Name Qty Qty
Qty
Qty
Qty
316 Other Bearings 1 0
1
0
0
Each
515 Steel Protective Coating 1 0
1
0
0
Square Feet
Element
Maint
Number Defect Type Defect Description
CS
CS Qty
Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 8 BEARING
2
1
Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 8
2
1
1 Square Feet
Protective Coatings) BEARING

Structure Number: 850318
General Comments
Span 1
Other Bearing
Element
Number
316
515
Element Name
Other Bearings
Steel Protective Coating
Near Bearing
Inspection Date: 12/13/2017
Total
CS1
CS2
CS3
CS4
Qty
Qty
Qty
Qty
Qty
1
0
1
0
0 Each
1
0
1
0
0 Square Feet
Number �VIUUL I yNU �UIUUL �U�UI INLIUII �Q �Q WLy Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 9 BEARING 2 1 Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 9 2 1 1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1
Other Bearing
Element
Number
316
515
Element Name
Other Bearings
Steel Protective Coating
Far Bearing
Total
CS1
CS2
CS3
CS4
Qty
Qty
Qty
Qty
Qty
1
0
1
0
0 Each
1
0
1
0
0 Square Feet
Number vc .— i ypc vci--11Nuv11 .«y Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 9 BEARING 2 1 Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 9 2 1 1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1
Other Bearing
Element
Number
316
515
Element Name
Other Bearings
Steel Protective Coating
Near Bearing
Total
CS1
CS2
CS3
CS4
Qty
Qty
Qty
Qty
Qty
1
0
1
0
0 Each
1
0
1
0
0 Square Feet
Element Maint
Number Defect Type Defect Description CS CS Qty Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 10 BEARING 2 1 Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 10 2 1 1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1
Other Bearing
Element
Number
316
515
Element Name
Other Bearings
Steel Protective Coating
Far Bearing
Total
CS1
CS2
CS3
CS4
Qty
Qty
Qty
Qty
Qty
1
0
1
0
0 Each
1
0
1
0
0 Square Feet
Element Maint
Number Defect Type Defect Description CS CS Qty Qty

Structure Number: 850318
Inspection Date: 12/13/2017
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 10 BEARING
2
1
Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 10
2
1
1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1 Near Bearing
Other Bearing
Element Total CS1
CS2
CS3
CS4
Number Element Name Qty Qty
Qty
Qty
Qty
316 Other Bearings 1 0
1
0
0
Each
515 Steel Protective Coating 1 0
1
0
0
Square Feet
Element
Maint
Number Defect Type Defect Description
CS
CS Qty
Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 11 BEARING
2
1
Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 11
2
1
1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1 Far Bearing
Other Bearing
Element Total CS1
CS2
CS3
CS4
Number Element Name Qty Qty
Qty
Qty
Qty
316 Other Bearings 1 0
1
0
0
Each
515 Steel Protective Coating 1 0
1
0
0
Square Feet
Element
Maint
Number Defect Type Defect Description
CS
CS Qty
Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 11 BEARING
2
1
Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 11
2
1
1 Square Feet
Protective Coatings) BEARING
General Comments
Span 1 Near Bearing
Other Bearing
Element Total CS1
CS2
CS3
CS4
Number Element Name Qty Qty
Qty
Qty
Qty
316 Other Bearings 1 0
1
0
0
Each
515 Steel Protective Coating 1 0
1
0
0
Square Feet
Element
Maint
Number Defect Type Defect Description
CS
CS Qty
Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 12 BEARING
2
1
Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 12
2
1
1 Square Feet
Protective Coatings) BEARING
General Comments

Structure Number: 850318
Span 1
Other Bearing
Element
Number Element Name
316 Other Bearings
515 Steel Protective Coating
Far Bearing
Inspection Date: 12/13/2017
Total
CS1
CS2
CS3
CS4
Qty
Qty
Qty
Qty
Qty
1
0
1
0
0 Each
1
0
1
0
0 Square Feet
Element Maint
Number Defect Type Defect Description CS CS Qty Qty
316 Corrosion SURFACE CORROSION THROUGHOUT BEAM 12 BEARING 2 1 Each
515 Effectiveness (Steel DETERIORATED PAINT SYSTEM THROUGHOUT BEAM 12 2 1 1 Square Feet
Protective Coatings) BEARING
General Comments
End Bent 1 Reinforced Concrete Footing 1
Reinforced Concrete Footing
Element Total CS1 CS2 CS3 CS4
Number Element Name Qty Qty Qty Qty Qty
220 Reinforced Concrete Pile Cap/Footing 42 18 22 2 0 Feet
Element Maint
Number Defect Type Defect Description CS CS Qty Qty
220 Abrasion/Wear 18" X 4" X 4" DEEP LOSS OF SECTION ALONG BOTTOM OF 3 2 2 Feet
(PSC/RC) FOOTING BENEATH BAY 10 (SEE PHOTO)
220 Abrasion/Wear UP TO 7" HIGH SCALING WITH EXPOSED AGGREGATE 2 22 Feet
(PSC/RC) ALONG FOOTING AT WATER SURFACE, CONDITION
BENEATH BAY 4 SHOWN IN PHOTO
General Comments
End Bent 2 Abutment
Reinforced Concrete Abutment
Element
Number Element Name
215 Reinforced Concrete Abutment
Total
CS1
CS2
CS3
CS4
Qty
Qty
Qty
Qty
Qty
42
39
1
2
0 Feet
Number uetect type uetect uescnption U5 U5 Utty Qty
215 Cracking (RC and UP TO 1/8" VERTICAL AND DIAGONAL CRACK IN FACE OF 3 2 2 Feet
Other) BACKWALL EXTENDING INTO BREASTWALL IN BAY 6 (SEE
PHOTO)
215 Delamination/Spall TWO (2) SPALLS UP TO 5" X 4" X 1" DEEP IN FACE OF CAP 2 1 1 Feet
BENEATH BEAM 1 (SEE PHOTO)
General Comments
End Bent 2 Reinforced Concrete Footing 1
Reinforced Concrete Footing
Element
Number Element Name
220 Reinforced Concrete Pile Cap/Footing
Total
CS1
CS2
CS3
CS4
Qty
Qty
Qty
Qty
Qty
42
23
7
12
0 Feet
Element Maint
Number Defect Type Defect Description CS CS Qty Qty
220 Abrasion/Wear 12' X 12" X 3" DEEP LOSS OF SECTION IN FACE OF 3 12 12 Feet
(PSC/RC) FOOTING FROM BAYS 1 TO 8 (SEE PHOTO)
220 Abrasion/Wear UP TO 7" HIGH SCALING WITH EXPOSED AGGREGATE 2 7 Feet
(PSC/RC) ALONG FOOTING AT WATER SURFACE FROM BAY 9 TO
RIGHT END

Structure Number: 850318 Inspection Date: 12/13/2017
General Comments

Elements Verfied
Location
Name
Component
Element Name
Amount
Span 1
Deck
Timber Deck
Timber Deck
553
Span 1
Beam 1
Plate Girder
Steel Open Girder/Beam
25
Span 1
Beam 2
Plate Girder
Steel Open Girder/Beam
25
Span 1
Beam 3
Plate Girder
Steel Open Girder/Beam
25
Span 1
Beam 4
Plate Girder
Steel Open Girder/Beam
25
Span 1
Beam 5
Plate Girder
Steel Open Girder/Beam
25
Span 1
Beam 6
Plate Girder
Steel Open Girder/Beam
25
Span 1
Beam 7
Plate Girder
Steel Open Girder/Beam
25
Span 1
Beam 8
Plate Girder
Steel Open Girder/Beam
25
Span 1
Beam 9
Plate Girder
Steel Open Girder/Beam
25
Span 1
Beam 10
Plate Girder
Steel Open Girder/Beam
25
Span 1
Beam 11
Plate Girder
Steel Open Girder/Beam
25
Span 1
Beam 12
Plate Girder
Steel Open Girder/Beam
25
Span 1
Left Bridge Rail
Timber Rail
Timber Bridge Railing
27
Span 1
Right Bridge Rail
Timber Rail
Timber Bridge Railing
27
Span 1
Wearing Surface
Asphalt Wearing Surface
Wearing Surface
527
Span 1
Near Bearing
Other Bearing
Other Bearings
1
Span 1
Far Bearing
Other Bearing
Other Bearings
1
Span 1
Near Bearing
Other Bearing
Other Bearings
1
Span 1
Far Bearing
Other Bearing
Other Bearings
1
Span 1
Near Bearing
Other Bearing
Other Bearings
1
Span 1
Far Bearing
Other Bearing
Other Bearings
1
Span 1
Near Bearing
Other Bearing
Other Bearings
1
Span 1
Far Bearing
Other Bearing
Other Bearings
1
Span 1
Near Bearing
Other Bearing
Other Bearings
1
Span 1
Far Bearing
Other Bearing
Other Bearings
1
Span 1
Near Bearing
Other Bearing
Other Bearings
1
Span 1
Far Bearing
Other Bearing
Other Bearings
1
Span 1
Near Bearing
Other Bearing
Other Bearings
1
Span 1
Far Bearing
Other Bearing
Other Bearings
1
Span 1
Near Bearing
Other Bearing
Other Bearings
1
Span 1
Far Bearing
Other Bearing
Other Bearings
1
Span 1
Near Bearing
Other Bearing
Other Bearings
1
Span 1
Far Bearing
Other Bearing
Other Bearings
1
Span 1
Near Bearing
Other Bearing
Other Bearings
1
Span 1
Far Bearing
Other Bearing
Other Bearings
1
Span 1
Near Bearing
Other Bearing
Other Bearings
1
Span 1
Far Bearing
Other Bearing
Other Bearings
1
Span 1
Near Bearing
Other Bearing
Other Bearings
1
Span 1
Far Bearing
Other Bearing
Other Bearings
1
End Bent 1
Abutment
Reinforced Concrete Abutment
Reinforced Concrete Abutment
42
End Bent 1
Reinforced Concrete Footing
Reinforced Concrete Pile Cap/Footing
42
End Bent 2
Abutment
Reinforced Concrete Abutment
Reinforced Concrete Abutment
42
End Bent 2
Reinforced Concrete Footing
Reinforced Concrete Pile Cap/Footing
42

General Inspection Notes

National Bridge and NC Inspection Items
Structure Number: 850318 Inspection Date: 12/13/2017
National Bridge Inventory Items
Item
Grade Scale
Grade
Item 58: Deck
0 - 9, N
7
Item 59: Superstructure
0-9, N
7
Item 60: Substructure
0-9, N
6
Item 61: Channel and Channel Protection
0 - 9 , N
7
Item 62: Culvert
0 - 9 , N
N
Item 71: Waterway Adequacy
0 - 9 , N
7
Item 72: Approach Roadway Alignment
0 - 9, N
8
Note: If NBI Inspection Item is not present, code NBI item with "N"
NC SMU Inspection Items
Item
Grade Scale
Grade
Maint. Qty.
Maint. Code
Deck Debris
G, F, P, or C
F
527
3376
Drainage System
G, F, P, or C
G
0
3332
Utilities
G, F, P, or C
Slope Protection
G, F, P, or C
0
3352
Scour
G, F, P, or C
G
Wingwall
G, F, P, or C
0
3350
Field Scour Evaluation
O
Drift
G, F, P, or C
G
0
3366
Fender System
G, F, P, or C
0
3364
Movable Span Machinery
G, F, P, or C
Response to Live Load
G, F, P, or C
G
Estimated Remaining Life
0 - 100 Years
32
Superstructure Paint Code
U
Note: If NC SMU Insepction Item is not present, leave NC SMU item blank
Inspection Information
Item
Grade Scale
Grade
Sign Noticed Issued
YES/NO
N
Priority Maintenance Request Submitted
YES/NO
N
Inspection Time
Hours
5
Traffic Control Time
Hours
Snooper Time
Hours
Ladder Used
YES/NO
N
Bucket Truck Used
YES/NO
N
Boat Used
YES/NO
N
Other Equipment Used
YES/NO
N

National Bridge and NC SMU Inspection Item Details
Structure Number: 850318 Inspection Date: 12/13/2017
Item Substructure - Item 60 Grade 6 Maint Code Qty. 0
Details ABUTMENT LENGTH INCLUDES WINGWALLS
Item Presently Posted
Details SV 23 TTST 31
Grade Y Maint Code Qty. 0
Item Deck Debris Grade F Maint Code 3376 Qty. 527
Details DIRT AND GRAVEL ACCUMULATION THROUGHOUT TOP OF DECK (SEE PHOTO)

Structure: 850318 County: SURRY Date: 12/13/2017 Condition Photos
r! tx
is
Span 1 Wearing Surface: 48" LONG X UP TO 1/4" X FULL DEPTH TRANSVERSE REFLECTIVE CRACK IN LEFT
SHOULDER, APPROXIMATELY T FROM ABUTMENT 1
ik
DIRT AND GRAVEL ACCUMULATION THROUGHOUT TOP OF DECK

Structure: 850318 County: SURRY Date: 12/13/2017 Condition Photos
Span 1 Left Bridge Rail: UP TO 1/8" X 1/2" DEEP CHECKS THROUGHOUT TOP BOARD, CHECKS
APPROXIMATELY 4' FROM ABUTMENT 2 SHOWN
Span 1 Beam 4 Near Bearing: SURFACE CORROSION THROUGHOUT BEAM 4 BEARING

Structure: 850318 County: SURRY Date: 12/13/2017 Condition Photos
End Bent 1 Footing: 18" X 4" X 4" DEEP LOSS OF SECTION ALONG BOTTOM OF FOOTING BENEATH BAY 10
End Bent 1 Footing: UP TO 7" HIGH SCALING WITH EXPOSED AGGREGATE ALONG FOOTING AT WATER
SURFACE, CONDITION BENEATH BAY 4 SHOWN

Structure: 850318 County: SURRY Date: 12/13/2017 Condition Photos
Span 1 Right Bridge Rail: UP TO 1/16" CHECKS THROUGHOUT SPACERS, CHECKS IN SPACER AT POST 5
SHOWN
End Bent 2 Abutment/Backwall: UP TO 1/8" VERTICAL AND DIAGONAL CRACK IN FACE OF BACKWALL
EXTENDING INTO BREASTWALL IN BAY 6

Structure: 850318 County: SURRY
Date: 12/13/2017 Condition Photos
t •�,' i�M ..
Fd'
�1:1 r
^sue
End Bent 2 Abutment/Backwall: TWO (2) SPALLS UP TO 5" X 4" X 1" DEEP IN FACE OF CAP BENEATH BEAM 1
End Bent 2 Footing: 12' X 12" X 3" DEEP LOSS OF SECTION IN FACE OF FOOTING FROM BAYS 1 TO 8

Structure: 850318 County: SURRY
Date: 12/13/2017 Structure Photos
LOOKING EAST
POSTING SIGN AT WEST APPROACH, POSTING SIGN AT EAST APPROACH SIMILAR

Structure: 850318 County: SURRY Date: 12/13/2017 Structure Photos
RIGHT RAIL, LEFT RAIL SIMILAR
EAST APPROACH, LOOKING WEST

Structure: 850318 County: SURRY Date: 12/13/2017 Structure Photos
I
m
UNDERDECK
ABUTMENT 2, ABUTMENT 1 SIMILAR

Structure: 850318 County: SURRY Date: 12/13/2017 Structure Photos
BEAM 9 BEARING AT ABUTMENT 2, OTHERS SIMILAR
LOOKING UPSTREAM, NORTH

• " Y'
IMM -+

Structure: 850318 County: SURRY Date: 12/13/2017 Structure Photos
DOWNSTREAM PROFILE, LOOKING NORTH

Stream Bed Soundinqs
(Profile diagram on following sheet)
County SURRY Structure Number: 850318 Inspection Date 12/05/2017
Sounding recorded from: Top of Bridge Rail
Highwater Mark Distance 7 Location of Highwater Mark DRIFT ON BANKS
Distance
(Station) ft.
0.000
Downstream
Sounding ft.
3.000
Upstream
Sounding ft.
0.000
Description
TOP OF WINGWALL
0.100
4.600
0.000
TOP OF CAP
1.000
4.600
0.000
TOP OF CAP
1.100
8.500
0.000
TOP OF FOOTING
2.000
8.500
0.000
TOP OF FOOTING
2.100
10.200
9.700
GROUND AT FOOTING
3.000
10.400
0.000
WSWE
5.000
10.600
0.000
10.000
10.600
0.000
15.000
10.700
0.000
20.000
10.500
0.000
22.500
10.400
0.000
WSWE
24.000
10.300
8.500
GROUND AT FOOTING
24.100
9.000
0.000
TOP OF FOOTING
24.500
9.000
0.000
TOP OF FOOTING
24.600
4.700
0.000
TOP OF CAP
25.200
4.700
0.000
TOP OF CAP
25.300
3.000
0.000
TOP OF WINGWALL

Bridqe: 850318 County: SURRY Date: 12/13/2017
STREAMBED PROFILE (Downstream)
Top of Rail = OFT (Sounding)
■ Water Surface ■ 12/13/2017 ■ 12/1/2015 ■ 12/10/2013 12/19/2011 ■ 3/9/2010 5/21/2008 Ll 7/10/2006
0
2
4
c
c 6
0
0
8
10
0 10 20 30
Distance (FT)

Structure Data Worksheet
Span Profile
County: SURRY Structure Number: 850318
B:t3EARING TO aEARING
C:DISTANCE FROM NEAR BEARING
F.-DISTANCE TO FAR BEARING
Span
Number
Span
Length
Bearing to
Bearing
Crutch/ Helper
Bent
Distance to
Near Bearing
Distance to
Far Bearing
1
26.330
0.000

NATIONAL BRIDGE INVENTORY-------- STRUCTURE INVENTORY AND APPRAISAL Run Date: 05/29/2018
IDENTIFICATION
(1) STATE NAME -NORTH CAROLINA BRIDGE
850318
SUFFICIENCY RATING =
84.86
(8) STRUCTURE NUMBER(FEDERAL) 000000001710318
STATUS = Not Deficient
(5) INVENTORY ROUTE (ON/UNDER) - ON
31013190
(2) STATE HIGHWAY DEPARTMENT DISTRICT
1
CLASSIFICATION
CODE
(3) COUNTY CODE 171 (4) PLACE CODE
0
(112)NBIS BRIDGE SYSTEM -
YES
(6) FEATURE INTERSECTED - UT TO S.FORK MICHELL RVR.
(104)HIGHWAY SYSTEM Is not on NHS
0
(7) FACILITY CARRIED SR1319
(26) FUNCTIONAL CLASS - Local
09
(9) LOCATION 40 FT.W.JCT.SR1318
(100)STRAHNET HIGHWAY- Not a STRAHNET Route
0
(11)MILEPOINT
0
(101)PARALLEL STRUCTURE- No Parallel Structure
N
(16)LAT 36° 22' 28.85" (17)LONG 80° 52' 35.68"
(102)DIRECTION OF TRAFFIC - 2-way Traffic
2
(98)BORDER BRIDGE STATE CODE PCT SHARE
(103)TEMPORARY STRUCTURE -
(99)BORDER BRIDGE STRUCTURE NO
(110)DESIGNATED NATIONAL NETWORK - Not on the National Network
0
(20) TOLL On Free Road
3
STRUCTURE TYPE AND MATERIAL
(31) MAINTAIN - State Highway Agency
01
(43) STRUCTURE TYPE MAIN: Steel
(22) OWNER - State Highway Agency
01
TYPE- Stringer Mutlibeam or Girder
CODE 302
(37) HISTORICAL SIGNIFICANCE - Not Eligible
5
(44) STRUCTURE TYPE APPR :
TYPE-
CODE 000
CONDITION
CODE
(45) NUMBER OF SPANS IN MAIN UNIT
1
(58) DECK
7
(46) NUMBER OF APPROACH SPANS
(59) SUPERSTRUCTURE
7
(107)DECK STRUCTURE TYPE - 8
CODE
(60) SUBSTRUCTURE
6
(108)WEARING SURFACE / PROTECTIVE SYSTEM:
(61) CHANNEL & CHANNEL PROTECTION
7
(A) TYPE OF WEARING SURFACE -
CODE
(62) CULVERTS
N
(B) TYPE OF MEMBRANE -
CODE
LOAD RATING AND POSTING
CODE
(C) TYPE OF DECK PROTECTION -
CODE
(31) DESIGN LOAD Unknown
0
(63) OPERATING RATING METHOD - Load Factor
1
AGE AND SERVICE
(64) OPERATING RATING - HS-23
41
(27) YEAR BUILT
1960
(65) INVENTORY RATING METHOD - Load Factor
1
(106)YEAR RECONSTRUCTED
(66) INVENTORY RATING - HS-14
25
(42) TYPE OF SERVICE: ON - Highway
(70) BRIDGE POSTING - Posting Required
3
UNDER - Waterway
CODE 15
(41) STRUCTURE OPEN, POSTED ,OR CLOSED
P
(28) LANES: ON STRUCTURE 2 UNDER STRUCTURE
0
DESCRIPTION - Posted for Load
(29) AVERAGE DAILY TRAFFIC
50
APPRAISAL
CODE
(30) YEAR OF ADT 2000 (109) TRUCK ADT PCT
%
(67) STRUCTURAL EVALUATION
6
(19) BYPASS OR DETOUR LENGTH
2 MI
(68) DECK GEOMETRY
4
GEOMETRIC DATA
(69) UNDERCLEARANCES,VERTI & HORIZ
N
(48) LENGTH OF MAXIMUM SPAN
24 FT
(71) WATERWAY ADEQUACY
7
(49) STRUCTURE LENGTH
26 FT
(72) APPROACH ROADWAY ALIGNMENT
8
(50)CURB OR SIDEWALK: LEFT .375 FT RIGHT
.375 FT
(36) TRAFFIC SAFETY FEATURES
0000
(51) BRIDGE ROADWAY WIDTH CURB TO CURB
20 FT
(113)SCOUR CRITICAL BRIDGES
U
(52) DECK WIDTH OUT TO OUT
21 FT
PROPOSED IMPROVEMENTS
(32) APPROACH ROADWAY WIDTH (W/SHOULDERS)
18 FT
(75) TYPE OF WORK - CODE
(33) BRIDGE MEDIAN - No Median
CODE 0
(76) LENGTH OF STRUCTURE IMPROVEMENT
(34) SKEW 19° (35) STRUCTURE FLARED
0
(94) BRIDGE IMPROVEMENT COST
(10) INVENTORY ROUTE MIN VERT CLEAR
999.9 FT
(95) ROADWAY IMPROVEMENT COST
(47) INVENTORY ROUTE TOTAL HORIZ CLEAR
20 FT
(96) TOTAL PROJECT COST
(53) MIN VERT CLEAR OVER BRIDGE RDWY
999.9 FT
(97) YEAR OF IMPROVEMENT COST ESTIMATE
(54) MIN VERT UNDERCLEAR REF Not a Highway or Railroad
0 FT
(114)FUTURE ADT 100 (115) YEAR FUTURE ADT
2025
(55) MIN LAT UNDERCLEAR RT REF Not a Highway or Railroad
000 FT
(56) MIN LAT UNDERCLEAR LT REF -
000 FT
INSPECTIONS
(90) INSPECTION DATE 12/13/2017
NAVIGATION DATA
(92) CRITICAL FEATURE INSPECTION: (93) CFI DATE
(38) NAVIGATION CONTROL - No Navigational Control
CODE 0
A) FRACTURE CRIT DETAIL - NO A)
(111)PIER PROTECTION -
CODE
B) UNDERWATER INSP - NO B)
(39) NAVIGATION VERTICAL CLEARANCE
0
C) OTHER SPECIAL INSP NO C)
(116)VERT - LIFT BRIDGE NAV MIN VERT CLEAR
FT
SCOUR
(40) NAVIGATION HORIZONTAL CLEARANCE
0 FT

BRIDGE MANAGEMENT UNIT
DATA ON EXISTING STRUCTURE Run Date: 05/29/2018
COUNTY:
DIVISION: DISTRICT: STRUCTURE NUMBER: LENGTH:
SURRY
11 1 850318 26
FEET
ROUTE CARRIED:
FEATURE INTERSECTED :
SR1319 UT TO S.FORK MICHELL RVR.
LOCATED:
BRIDGE NAME:
40 FT.W.JCT.SR1318 CITY:
FUNC. CLASS :
SYST.ON : SYST.UNDER : ADT & YR : RAIL TYPE:
09
NFA NFA 50 2000 LT 227 RT 227
BUILT:
BY: PROJ : FED.AID PROJ : DESIGN LOAD:
1960
BMU Unknown
REHAB: BY: PROJ: ALIGNMENT: SKEW: LANES:
TAN 109 ON 2 UNDER
0
NAVIGATION:
HT. CRN. TO BED: WATER DEPTH:
VC 0
FT HC 0 FT 8 FT 1
FT
SUPERSTRUCTURE:
TIMBER FLOOR ON I -BEAMS
SUBSTRUCTURE:
ABUTMENTS: REINFORCED CONCRETE
SPANS:
1 @ 26'4
BEAMS OR GIRDERS:
12 LINES 12 I -BEAMS @ V-8" CENTERS
FLOOR:
ENCROACHMENT: DECK (OUT TO OUT) :
4X8 TIM/NO
21 FT
AWS
CLEAR ROADWAY:
BETWEEN RAILS: SIDEWALK OR CURB:
20 FT 20.75 FT LT .375 FT RT
.375 FT
VERT.CL.OVER :
999.9 FT
INV.RTG.:
OPE.RTG.: CONTR.MEMBER : POSTED:
HS-14
HS-23 IntBeam SV 23 TTST 31 DATE 03/12/2012
SYSTEM:
GREEN LINE ROUTE:
Secondary S.R. Route
N
UNDER ROUTES AND CLEARANCES
REMARKS:

Bridge Inspection Field Sketch
Roadway
18ft Wide
1 Unpaved Lane
Looking East
Left Shoulder
Eft Wide
Eft Unpaved
Right -Shoulder
5ft Wide
Eft Unpaved
Left Guardrail
Right Guardrail
Measurements recorded approximately 20ft from bridge along centerline of roadway.
SKETCH REVISIED BY DRC ON 12.13.17
Title Description
APPROACH ROADWAY LOOKING EAST
Brifte NO: 850318 1 Drawn By: R. CORNEJO I Date: 12/01/2015 1 File Name:S0138001429

Bridge Inspection Field Sketch
Deck Width/Outto out
21.011
Between Rails
20.75ft
Clear Roadway
20.0ft
Wearing.$urface
0.042ftMedian
Width
Median Heicht
Curb Hei ht
Left
1 0.958ft
Right
0.958ft
Sidewalk Width
Left
I
Rht
Clear Roadway Rail to Median
Left
Right
Guardrail Width
Left
I 0.5ft
Right
0.5ft
Top of Rail to DeckWearing Surface
Left
1 2.917ft
I Right
12.917ft
Brid a Rail
Left
1 Type 22
1 Ri ht
Type 22
ONE THRU LANE IN EACH DIRECTION
Measurements for Span
1
Deck Thickness
0.333
Left Overhana
1.333
Top of Rail to Bottom of Beam
4.583
Right Oveftn
1.333
Beam Number
Beam Type
SpacingComments
1
Steel I Beam
1.667ft
2
Steel I Beam
1.667ft
3
Steel I Beam
1.667ft
4
Steel I Beam
1.667ft
5
Steel I Beam
1.667ft
6
Steel I Beam
1.667ft
7
Steel I Beam
1.667ft
8
Steel I Beam
t667ft
9
Steel I Beam
1.667ft
10
Steel I Beam
1,667ft
11
Steel I Beam
1.667ft
12
Steel I Beam
M
r
1- 5116"
14 6 1/2"
BEAMS 1, 2. 3, 5. 6,
7 AND 9 THRU 12 DETAILS
�.7
1-7/16"
6 1 /2" ` I
Title Description
TYPICAL SECTION 12 LINES OF STEEL 1-BEAMS
Brittae Na: 850318 1 Drawn By: R. CORNEJO I Date: 12101/2015 1 File Nome:SO138001430

Bridge Inspection Field Sketch
6" 12"
r
SIDE VIEW
SKETCH VERIFIED BY DRC ON 12.13.17
Title
ABUTMENTS
Description
SIDE VIEW
Bridge NO: 850318
Drawn By: RAP
Date: 07/11/2006
File NomeSO138001431

Bridge Inspection Field sketch
End of Beam at
End Bent 1
End of Beam at
End Bent 2
(D r i 0 0 0
1.5'
5.5'
5.5'
5.5'
5.5'
1.5'
BEAM 4
Hole Diameter = 314"
SKETCH VERIFIED BY DRC ON 12.13.17
Title
SALVAGED BEAMS
Description
BEAM 4
Bridge No- 850318
Drawn By: R. CQRNEJD
Date: 12/01/2015
File Name50518000186

Match Bridges
Sources and Uses of Funds for the GREATTER-NC Program
Summary
Design
ROW
Utilities
Construction
Total
Total (All 77 bridges)
Non federal sources
$ 8,204,341
$ 4,000,639
$ 6,056,215
$ 75,878,580
$ 94,139,775
BUILD
$ 2,124,649
$ 847,465
$ 848,185
$ 21,179,701
$ 25,000,000
Other federal
$ -
$ -
$ -
$ -
$ -
Match Bridges
Non-federal sources
$ 7,754,190
$ 3,820,584
$ 5,876,160
$ 71,377,001
$ 88,827,935
BUILD
$ -
$ -
$ -
$ -
$ -
Other federal
$ -
$ -
$ -
$ -
$ -
Posted Bridges
Non-federal sources
$ 450,151
$ 180,055
$ 180,055
$ 4,501,579
$ 5,311,840
BUILD
$ 2,124,649
$ 847,465
$ 848,185
$ 21,179,701
$ 25,000,000
Other federal
$ -
$ -
$ -
$ -
$ -
Individual Bridges
Design
ROW
Utilities
Construction
Total
850318
Non-federal sources
$ 5,695
$ 2,278
$ 2,278
$ 56,954
$ 67,205
BUILD
$ 26,805
$ 10,722
$ 10,722
$ 268,046
$ 316,295
Other federal
$ -
$ -
$ -
$ -
$ -
$ 119,139,775
$ 30,311,840
383,500

Total AADT
STR_No Total Injury Fatal A_Inj B_Inj C_Inj PDO Unk (2016) Truck%
850318 0 0 0 0 0 0 0 0 1300 6%
Total 84 19 1 1 7 10 63 2
Crash Reduction
- Total Crashes
Crash Reduction
- Total Injury
Crashes (K,A,B,C)
0
0
18.48
6.08
3.70
1.22
5-year
crash
reduction
crash
reduction
per year

Bridge Traffic Review Sheet
TIP:
County:
Bridge Number and Location:
Reviewer:
Date:
Base Year:
Base Year AADT Estimate
Is the bridge location modeled with an approved model?
Historic AADT Location:
Comments:
Class Data
Result:
BR-0123
Surry
BRIDGE 850318 ON SR1319 OVER LIT OF S FORK MITCHELL F
Keith Dixon
10/2/2018
2015
290
No
SR 1322 E OF SR 1301
2015
290
2014
2013
240
2012
2011
340
2010
2009
320
2008
2007
310
2006
N/A
Assume Minimum Design Standards

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER
GOVERNOR 6/7/2019
MEMORANDUM TO: Michelle Lopez
Transportation Planner STV Inc.
JAMES H. TROGDON, III
SECRETARY
FROM: Gordon Box, PG DocuSigned by,
GeoEnvironmental Project Manager
GeoEnvironmental Section ooA,A,oaEsoea�9...
Geotechnical Engineering Unit
TIP NO:
BR-0123
WBS:
67123.1.1
COUNTY:
SURRY
DIVISION
11
DESCRIPTION:
Bridge Number 850318 on SR1319 over UT of South Fork Mitchell River
SUBJECT: Pre-Scoping Comments
The GeoEnvironmental Section performed a records search of readily available information for the given
project study area to identify known and potential sites of concern. No sites of concern were identified within
the project area. If the project limit changes, please let us know, so we can reevaluate the study area.
cc:
Kevin Fischer, PE, Assistant State Structures Engineer - PEF Coordination, Program Management & Field
Ops.
John Pilipchuk, LG, PE, State Geotechnical Engineer
Brian Hanks, PE, State Structures Engineer
Dale Burton, PE, PLS, State Locations and Surveys Engineer
Carl Barclay, PE, State Utilities Manager
Trent Beaver, PE, Division Construction Engineer
Daneil Miles, Division Right of Way Agent
Eric Williams, PE, Geotechnical Regional Manager
Kevin Miller, PG, Regional Geological Engineer
Heather Fulghum, State Negotiator
row-notifyAncdot. goy
roadwaydesi gn(a,ncdot. gov
hydraulics _notifykncdot. og_v
File
Mailing Address:
NC DEPARTMENT OF TRANSPORTATION
GEOTECHNICAL ENGINEERING UNIT
1589 MAIL SERVICE CENTER
RALEIGH NC 27699-1589
Telephone: [phone]
Fax: [phone]
Customer Service: 1-877-368-4968
Website: www.ncdot.eov
Location:
CENTURY CENTER COMPLEX
ENTRANCE B-2
1020 BIRCH RIDGE DRIVE
RALEIGH NC

GeoEnvironmental Pre-Scoping Comments
T.I.P.#: BR-0123
Page 2 of 2
Vicinity Map
Project Study Arep
SURRY
COUNTY
USES Topo Quads - Roaring Gap, Bottom, Thurmond & Elkin North
0 500 1,000 2.000
Feet I BR-01 23

BR-0123 (850318)
• A PDR is available for this site. Please let me know if a copy needs
to be provided. The summary of the PDR is listed below:
o South Fork Mitchell River Tributary 2B
■ Class C
■ Yadkin Pee -Dee River Basin
■ DA z 1.00 mil (FEMA)
■ Limited Detailed Study
• Possible Structures Impacted: No structures
observed in the 100-yr floodplain.
• RS=315
• Q 100 = 743 cfs

Cashmore, Blake A.
From: Lopez, Michelle
Sent: Friday, May 10, 2019 5:22 PM
To: Smith, Garold D.
Subject: FW: [External] Start of Study Notifications: Bridge No. 318 in Surry County (BR-0123)
From: Harris, James B [mailto:[e-mail]]
Sent: Friday, May 10, 2019 2:55 PM
To: Lopez, Michelle <[e-mail]>
Subject: RE: [External] Start of Study Notifications: Bridge No. 318 in Surry County (BR-0123)
**This e-mail is from outside STV**
Michelle —
Rail Division does not have any comments since no rail is involved on this project. Thank you. - - Jim
James B. Harris, PE
State Railroad Coordination Engineer
Rail Division
North Carolina Department of Transportation
919 707 4707 office
ibharris(c�ncdot.gov
1 South Wilmington Street
1553 Mail Service Center
Raleigh, NC 27699-1553
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Lopez, Michelle <[e-mail]>
Sent: Monday, May 06, 2019 2:20 PM
Cc: Smith, Garold D. <[e-mail]>; 4019918 <[e-mail]>
Subject: [External] Start of Study Notifications: Bridge No. 318 in Surry County (BR-0123)
External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
[e-mail]
Good Afternoon,

STV Engineers Inc., under contract with the Structures Management Unit, is starting the project development,
environmental and engineering studies for the replacement of the following:
Bridge No. #318 in Surry County.
The current project schedule is for right of way in 2019 and construction in 2020.
NCDOT is starting the project development, environmental and engineering studies for the replacement of Bridge No.
318 on SR-1319, over UT of South Fork Mitchell River, in Surry County. The project vicinity and study area maps are
attached.
A Field Scoping Meeting took place on April 17, 2019.
We would appreciate any information you might have that would be helpful in evaluating potential environmental
impacts of the project including recommendation of alternates to be studied. Your comments may be used in the
preparation of an environmental document, in accordance with the State or Federal Environmental Policy Act.
Please respond by June 6th so that your input can be used in the scoping of this project. If you have no comment at this
time, then a response is not required.
If you have any questions concerning this project, please contact me at [e-mail].
STV 100
Michelle Lopez
Transportation Planner
1600 Perimeter Park Drive, Suite 225
Morrisville, North Carolina 27560
Direct: 919-238-6673
Please consider the environment before printing this e-mail.
Redesigned and rebuilt: visit our new website at www.stvinc.com
191
191191191
The information contained in this electronic message is intended only for the use of the individual or entity to
which it is addressed and may contain information that is privileged, confidential and exempt from disclosure
under applicable law. If the reader of this message is not the intended recipient, you are informed that any
dissemination, copying or disclosure of the material contained herein, in whole or in part, is strictly prohibited.
If you have received this transmission in error, please notify STV and purge this message.

Email correspondence to and from this sender is subject to the N.C. Public Records a and ma be disclosed to third parties.

N4RFIi Cd Ri}LINd
$TdTE PA(tKS
Division of Parks and Recreation
NC Department of Natural and Cultural Resources
Governor Roy Cooper
May 10, 2019
Michelle Lopez
Transportation Planner
STV
1600 Perimeter Park Drive, Suite 225
Morrisville, NC 27560
Ms. Lopez,
Secretary Susi H. Hamilton
I have reviewed NCDOT project B-0123 Bridge Replacement in Surry County. Based on the
proposed project the North Carolina Division of Parks and Recreation (DPR) has no objections or
comments.
Please feel free to contact this office if you have any questions or comments.
Sincerely,
Michael Peveler
Environmental Review Coordinator
North Carolina Division of Parks and Recreation
[phone] / [e-mail]
Dwayne Patterson, Director
NC Division of Parks and Recreation
1615 MSC - Raleigh, NC 27699-1615
919.707.9300 / ncparks.gov
NORTH CAROLINA STATE PARKS
/11a" Wort

Cashmore, Blake A.
From: Ellwanger, Claire <[e-mail]>
Sent: Wednesday, June 05, 2019 9:12 AM
To: Lopez, Michelle
Subject: Re: [EXTERNAL] Notification of Start of Activities for NCDOT Structures Management
Bridge Program Bridge Replacement Projects to be Let in 2020: Bridge No. #318, 166, &
165 in Surry Co & Iredell Co
**This e-mail is from outside STV**
Ms. Lopez
On May 6 & 7, 2019 we received your emails requesting our comments on three North Carolina Department of
Transportation (NCDOT) bridge replacement projects. We submit the following comments and
recommendations in accordance with the provisions of Section 7 of the Endangered Species Act of 1973, as
amended (16 U.S.C. §§1531-1543); the Fish and Wildlife Coordination Act, as amended (16 U.S.C. §§661-
667e); the Clean Water Act (33 U.S.C. §1251 et seq.); the Migratory Bird Treaty Act (16 U.S.C. §§703-712);
and the National Environmental Policy Act (42 U.S.C. §4321 et seq.).
General Recommendations for Replacing Structures that Cross Rivers and Streams
We generally recommend the use of clear spanning bridge structures designed, at a minimum, to accommodate
the active channel width. Use of culverts is discouraged. Properly sized spanning structures will provide for
the passage of aquatic species and accommodate the movement of debris and bed material. Furthermore,
spanning structures usually: (1) can be constructed with minimal in stream impacts, (2) do not require stream
channel realignment, and (3) retain the natural streambed conditions; and the horizontal and vertical clearances
may be designed to allow for human and wildlife passage beneath the structures.
If possible, bridge supports (bents) should not be placed in the streams. Bents can collect debris during flood
events, resulting in the scouring of bridge foundations. In stream bents can also result in hydrologic changes,
such as bed scour or deposition, which may adversely affect in stream habitat. Deck drains of the spanning
structures should not discharge directly into the streams; instead, they should drain through a vegetated area
before entering the streams.
Removal of vegetation in riparian areas should be minimized. Armoring of the bank with riprap should be
minimized. The reseeding of disturbed areas should be performed promptly after grading, and seed mixes
should consist of native vegetation in order to prevent the spread of invasive plant species. New structures
should be constructed without the use of in stream causeways or work pads whenever possible. When
causeways are necessary, using the largest washed stone practicable for the application will prevent unnecessary
damage to in stream habitat and will facilitate complete removal. We recommend that all equipment be
refueled and receive maintenance outside of the floodplain. Refueling and maintenance should take place in
designated refueling sites that are provisioned to quickly contain any spills of fuel, lubricants, and other fluids.
Erosion and Sedimentation Control
Construction activities near streams, rivers, and lakes have the potential to cause water pollution and stream
degradation if measures to control site runoff are not properly installed and maintained. In order to effectively
reduce erosion and sedimentation impacts, best management practices specific to the extent and type of
construction should be designed and installed during land disturbing activities and should be maintained until
the project is complete and appropriate stormwater conveyances and vegetation are reestablished on the site.

A complete design manual, which provides extensive details and procedures for developing site specific plans
to control erosion and sediment and is consistent with the requirements of the North Carolina Sedimentation and
Pollution Control Act and Administrative Rules, is available at: http://portal.ncdenr.org/web/IL/Publications. For
maximum benefits to water quality and bank stabilization, riparian areas should be forested; however, if the
areas are maintained in grass, they should not be mowed. We recommend planting disturbed areas with native
riparian species. The U.S. Fish and Wildlife Service can provide information on potential sources of plant
material upon request.
Northern Long-eared Bat
Suitable summer roosting habitat may be present in the project area for the federally threatened northern long-
eared bat (Myotis septentrionalis). However, the final 4(d) rule (effective as of February 16, 2016), exempts
incidental take of northern long-eared bat associated with activities that occur greater than 0.25 miles from a
known hibernation site, and greater than 150 feet from a known, occupied maternity roost during the pup season
(June 1 — July 31). Based on the information provided, the project would occur at a location where any
incidental take that may result from associated activities is exempt under the 4(d) rule. Your project will likely
include tree clearing. Although not required, we encourage you to conduct any associated tree clearing
activities outside the pup season (June 1 to July 31) and/or active season (April 1 to October 31) to reduce
the chance of impacting unidentified maternity roosts.
Mi rg atory Birds
The MBTA (16 §U.S.C. 703-712) prohibits the intentional taking, killing, possession, transportation, and
importation of migratory birds, their eggs, parts, and nests, except when specifically authorized by the
Department of the Interior. To avoid impacts to migratory birds, we recommend conducting a visual inspection
of any migratory bird nesting habitat within the project area during the migratory bird nesting season of March
through September and avoiding impacting the nests during the migratory bird nesting season. If birds are
discovered nesting near the project area during years prior to the proposed construction date, we recommend
that you and the NCDOT, in consultation with US Fish and Wildlife Service, develop measures to discourage
birds from establishing nests within the project area by means that will not result in the take of birds or eggs; or
avoid construction activities during the nesting period.
The table below summarizes our comments for the proposed projects. Included in the table is the USFWS file
number that will aid us in referencing the appropriate file in the future. Please include this number in any future
correspondence. If you have questions about these comments please contact Ms. Claire Ellwanger of our staff at
828/258 3939, Ext. 235.
Bridge #
County
USFWS Comments
USFWS File #
Survey for Helianthus schweinitzii, assess habitat for
isotria medeoloides, recommend winter tree clearing for
850318
Surry
NLEB
19-262
Survey for Hexastylis naniflora, recommend winter tree
480166
Iredell
clearing for NLEB
19-261
Survey for Hexastylis naniflora, recommend winter tree
480165
Iredell
clearing for NLEB
19-260
On Mon, May 6, 2019 at 1:54 PM Lopez, Michelle <Joyce. Lopezgstvinc. com> wrote:
Good Afternoon,

NCDOT is starting the project development, environmental, and engineering studies for the replacement of Bridge No.
318 on SR-1319, over UT of South Fork Mitchell River, in Surry County. The project vicinity and study area maps are
attached.
The Department may be in contact with your agency in the near future, if applicable, requesting project specific
information.
No response to this notification is required, however we welcome your input if you have any specific or time -
critical concerns that the Department should be aware of. Your comments may be used in the preparation of an
environmental document, in accordance with the State or Federal Environmental Policy Act.
If you have any questions concerning this project, please contact me at [e-mail].
Thank you,
Michelle Lopez
TV too
r
Michelle Lopez
Transportation Planner
1600 Perimeter Park Drive, Suite 225
Morrisville, North Carolina 27560
Direct: 919-238-6673
Please consider the environment before printing this e-mail.
Redesigned and rebuilt: visit our new website at www.stvinc.com

141
141141141
The information contained in this electronic message is intended only for the use of the individual or entity to
which it is addressed and may contain information that is privileged, confidential and exempt from disclosure
under applicable law. If the reader of this message is not the intended recipient, you are informed that any
dissemination, copying or disclosure of the material contained herein, in whole or in part, is strictly prohibited.
If you have received this transmission in error, please notify STV and purge this message.
Claire Ellwanger
Biologist
U.S. Fish and Wildlife Service
160 Zillicoa St # B
Asheville, NC 28801
[phone] x 235

NCDOT Feasibility Studies Unit Bridge 850318'
SCREENING CHECKLIST
BRIDGE ID: 850318 FACILITY: SR1319 OVER UT OF SOUTH FORK DIVISION: 11
MITCHELL RIVER
YEAR BUILT: 1960 ' COUNTY: SURRY POSTED (SV/TTST): 23/31
COST ESTIMATE: $473,750
uvs r rcucr rUrvs: ine ronowrngquesuons are oaseaon me cc cnecKrrsrs ror i rrc ranrr n nrrrerrs Hnswereac!, rruesnon m me space
provided basedon available data. Include qualitative discussion as appropriate.
Does the project require formal consultation with U.S. Fish and Wildlife Service (USFWS) or National Marine
Fisheries Service (NMFS)?
A Natural Resources Technical Report (NRTR) must be prepared during projectdevelopment before this question can be fully answered.
Review the current USFWS Endangered and Threatened Species and Species of Concern by County forNorth Carolina and note
species or designated critical habitat listed in the county(s).
AS OF JUNE 27, 2018, THE USFWS LISTS THE SCHWEINITTS SUNFLOWER AS ENDANGERED
WITHIN SURRY COUNTY. THE NORTHERN LONG-EARED BAT AND THE SMALL WHORLED
POGONIA ARE LISTED AS THREATENED WITHIN SURRY COUNTY.
THE BOG TURTLE IS LISTED AS THREATENED DUE TO SIMILARITY OF APPEARANCE WITH
ANOTHER LISTED SPECIES AND IS LISTED FOR ITS PROTECTION. HOWEVER, THE BOG TURTLE IS
NOT BIOLOGICALLY ENDANGERED OR THREATENED AND IS NOT SUBJECT TO SECTION 7
CONSULTATION.
A CHECK OF THE CURRENT NCNHP DATABASE SHOWED ONE CURRENT OCCURRENCE OF A
FEDERALLY ENDANGERED SPECIES WITHIN 1 MILE OF THE PROPOSED PROJECT: BOG TURTLE
(EOID 11892, LAST OBSERVED IN 1997). 1
Does the project result in impacts subject to the conditions of the Bald and Golden Eagle Protection Act
(BGPA)?
A NRTR must be prepared during project development before this question can be fully answered. Review the current USFWS
Endangered and Threatened Species and Species of Concern by County for North Carolina and note if B GPA species are listedin the
county(s).
THE USFWS LIST FOR SURRY COUNTY DOES NOT INCLUDE THE BALD EAGLE. THE NCNHP
DATABASE DOES NOT SHOW ANY OCCURRENCES WITHIN 1 MILE OF THE PROPOSED PROJECT.
Does the project generate substantial controversy or public opposition, for any reason, following appropriate
public involvement?
ReviewonropiateCTPfordocumentationofnublicinvolvementinthe CTPdeveloprrentandany comnentsrelate dtothe nroject.
NO
Does the project cause disproportionately high and adverse impacts relative to low-income and/or minority
populations?
iris question vviiirequire additional evaluation during project deveropna_-ni. Using the NCDOTDernographic Tool, note the iotai
population, as well as rrinority and low-income populations forthe county and each Census Block Groun in which the projectis located.
Also note anyobservations basedon review of aerial photography.
THE PROJECT DEMOGRAPHIC STUDY AREA (DSA) CONTAINS PORTIONS OF 1 BLOCK GROUP.
THE MINORITY POPULATION OF THE DSA IS 3.7%. THIS COMPARES TO A MINORITY POPULATION
OF 15.5% FOR SURRY COUNTY. THE POVERTY RATE FOR THE DSA IS 17.3%. SURRY COUNTY'S
POVERTY RATE IS 15.4%.
THERE IS NO EVIDENCE OF LOW INCOME HOUSING IN THE VICINITY OF THE PROJECT VISIBLE ON
74

NCDOT Feasibility Studies Unit Bridge 850318
5 Does the project involve a residential or commercial displacement, or a substantial amount of right of way
acquisition?
Provw .i­)/,tofpotentialresidentialandcorrrercialdisplacements.
THERE ARE NO RESIDENTIAL OR COMMERCIAL STRUCTURES WITHIN THE PROJECT STUDY
AREA.
6 1 Does the project require an Individual Section 4(f) approval?
llus question writ require additionai evaluation duruig projecidevelopnEnr. Atthistirre, notethe presence ofproperties thatmaybe
subject to Section 4(f), including historic resources, parks, and wildlife/waterfowl refuges. Note those within the proposedright of way, as
well as within 1,000'ofthe project.
ACCORDING TO THE NC SHPO GIS DATABASE, THERE ARE NO NC SHPO RESOURCES WITHIN
1,000 FEET OF THE PROJECT.
THERE ARE NO PARKS OR WILDLIFE REFUGES WITHIN 1,000 FEET OF THE PROPOSED ROW.
7 Does the project include adverse effects that cannot be resolved with a Memorandum of Agreement (MOA)
under Section 106 of the National Historic Preservation Act (NHPA) or have an adverse effect on a National
Historic Landmark (NHL)?
i ni6 question wiii require additional evaluation during prcjectdeveiopr,-�--nt. Review NC State Historic Preservation Office GIS data ano
note the presence of historic properties within the Proposedright of way, as well as within 1000'nf the nrofecf_ Note this site dnesnot
include archaeological resources.
ACCORDING TO THE NC SHPO GIS DATABASE, THERE ARE NO NC SHPO RESOURCES WITHIN
1,000 FEET OF THE PROJECT.
8 Does the project result in a finding of "may affect not likely to adversely affect" for listed species, or
designated critical habitat under Section 7 of the Endangered Species Act (ESA)?
A iviti ti must be prepared during project deveiopiTientbefore this question can be fuilyanswered. Referto Question#1 above.
SEE #1 ABOVE
9 1 Is the project located in anadromous fish spawning waters?
Review the anadromous fish spawningareas maps to detemine if the project is within 1,000'ofthese areas
THERE ARE NO ANADROMOUS FISH SPAWNING WATERS WITHIN 1,000 FEET OF THE PROJECT.
10 Does the project impactwaters classified as Outstanding Resource Water (ORW), High Quality Water
(HQW ), Water Supply Watershed Critical Areas, 303(d) listed impaired water bodies, buffer rules, or
Submerged Aquatic Vegetation (SAV)?
Deterrrine the NCDEQ Surface Water Classification of any waters within 1,000' oftheproject, and note if any have a 'WS"(Water
Supply)classificationorsupplerrL-ntalclassificafionofORWorHQW. Check the current303d Iistfor303(d)listed waters within 1,000
feet of the project. Review the Division Resource Map to detemine if the project is within a watershed subject to buffer rules.
NONE OF THE WATERS WITHIN 1,000 FEET OF THE PROJECT ARE WITHIN WATER SUPPLY
WATERSHEDS OR CLASSIFIED AS ORW, HQW, OR LISTED ON THE FINAL 2014 303(D) LIST.
STATE BUFFER RULES DO NOT APPLY WITHIN THE YADKIN PEE-DEE RIVER BASIN, WHERE THE
PROJECT IS LOCATED.
THERE IS NO MAPPED SAV WITHIN 1,000 FEET OF THE PROJECT.
11 Does the project impact waters of the United States in any of the designated mountain trout streams?
Trout counties are identified on the PDEA Agency Merger Contact Map, and trout waters are identified by "Tr"classification in their
NCDEQ Surface Water Classification (see - =stion #10 abr I Detemir thin 1000'ofa trot ream
THERE ARE NO NCDEQ CLASSIFIED TROUT STREAMS OR DESIGNATED PUBLIC MOUNTAIN
TROUT WATERS WITHIN 1,000 FEET OF THE PROJECT.
12 Does the project require a U.S. Army Corps of Engineers (USACE) Individual Section 404 Permit?
This question wiiiiequire addttionai evaluation during piojectdevelopnent. Using express concepivai design right of way Brats and
National Wetlandlnventory(NWI) mapping, calculatepotential irrpacts to waters of the U.S. Note irrpactsto wetlands to the nearest 0.1
75

NCDOT Feasibility Studies Unit Bridge 850318
acre an
THERE ARE NO MAPPED NWI WETLANDS WITHIN THE PROJECT LIMITS.
BASED ON NHD FLOWLINES, THE PROJECT WOULD IMPACT APPROXIMATELY420 FEET OF
FRESHWATER STREAMS.
Will the project require an easement from a Federal Energy Regulatory Commission (FERC) licensed facility?
Review the Division Resource Map to determine if the project is within 1,000'ofa FERC licensed facility.
THERE ARE NO FERC LICENSED FACILITIES WITHIN 1,000 FEET OF THE PROJECT.
14 Does the project include a Section 106 of the NHPA effects determination other than a no effect, including
archaeological remains?
This question will require--litional evaluation during projectdeveloprrent. Referto Question #7 above.
SEE #7 ABOVE
15 Does the project involve hazardous materials and/or landfills?
Note any potential hazardous properties based on review of aerial photography orfromNC OneMap data.
THERE ARE NO HAZARDOUS MATERIALS OR LANDFILLS WITHIN 1,000 FEET OF THE PROJECT.
16 Does the project require work encroaching and adversely affecting a regulatory floodway or work affecting the
base floodplain (100-year flood) elevations of a water course or lake, pursuant to Executive Order 11988 and
23 CFR 650 subpart A?
Review NC Floodmaps data to determine whether the project n7ayencroach on any base (100-year) floodplain and/orregulatory
floodway.
THE PROJECT ROW LIMITS OCCUR WITHIN THE 100-YEAR FLOODPLAIN.
17 Is the project in a Coastal Area Management Act (CAMA) county and substantially affects the coastal zone
and/or any Area of Environmental Concern (AEC)?
A NRTR must be prepared during project development before this question can be fully answered. Review the Division Resource Map to
deterrine if the project is within CAMA county.
SURRY COUNTY IS NOT A CAMA COUNTY.
18 Does the project require a U.S. Coast Guard (USCG) permit?
Review NCDOT's USCG Stream Coordination Map to determne if the projectirrpacts a navigable waterway that may require
coordination and pemitting with the USCG.
THERE ARE NO NAVIGABLE WATERS WITHIN THE VICINITY OF THE PROJECT.
19 Does the project involve construction activities in, across, or adjacent to a designated Wild and Scenic River
I present within the project area?
Review the Division Resource Map to determne if the project is within 1,0007ofa Wild and Scenic River.
THERE ARE NO WILD AND SCENIC RIVIRS WITHIN 1,000 FEET OF THE PROJECT.
Does the project involve Coastal Barrier Resources Act (CBRA) resources?
Review the Division Resource Map to determine if the project is within a CBRA area.
THERE ARE NO CBRA AREAS WITHIN THE VICINITY OF THE PROJECT.
Does the project impactfederal lands (e.g. U.S. Forest Service (USFS), USFWS, etc.) or Tribal Lands?
Review the Division Resource Map to determine if the project is within federallands.
THERE ARE NO FEDERAL LANDS WITHIN THE VICINITY OF THE PROJECT.
22 Does the project involve any changes in access control?
76

NCDOT Feasibility Studies Unit Bridge 850318 '
Note if the project is proposing a change in control of access.
NO
23
Does the project have a permanent adverse effect on local traffic patterns or community cohesiveness?
This question will require additional evaluation during project development. At this time, note changes in traffic patterns andany
reduction in access to connunity resources.
NO
24 Will maintenance of traffic cause substantial disruption?
ALL PROPOSED IMPROVEMENTS AND CONSTRUCTION WOULD BE COMPLETED IN A MANNER TO
MINIMIZE DETOURS AND IMPACTS TO TRAFFIC. AN OFFSITE DETOUR COULD BE USED WITHOUT
SUBSTANTIALLY IMPACTING TRAFFIC PATTERNS AND ACCESS.
25
Is the project inconsistent with the STIP or the Metropolitan Planning Organization's (MPO's) Transportation
Improvement Program (TIP) (where applicable)?
This question will be evaluatedduring project development.
N/A
26
Does the project require the acquisition of lands under the protection of Section 6(f) of the Land and Water
Conservation Act, the Federal Aid in Fish Restoration Act, the Federal Aid in Wildlife Restoration Act,
Tennessee Valley Authority (TVA), or other unique areas or special lands that were acquired in fee or
easement with public -use money and have deed restrictions or covenants on the property?
A list of resources using funds provide through Section 6(f) of the Landand Water Conservation Fund (LWCF) is available at http://waso-
Iwcf.ncrc.nps.pov/publichndex.cfm Review the Division Resource Map to detemrne if the projectcrosses a TVA area. If parcel data is
available, use best availableinforrrationto deterrdne ifanyofthese situations exist.
THERE ARE NO UNIQUE AREAS OR SPECIAL LANDS THAT WERE ACQUIRED IN FEE OR
EASEMENT WITH PUBLIC USE MONEY WITHIN THE VICINITY OF THE PROJECT.
Does the project involve Federal Emergency Management Agency (FEMA) buyout properties under the
27
Hazard Mitigation Grant Program (HMGP)?
This question will require additional evaluation during projectdevelopment. Referto Question # 16 above, andif the project is within a
flood zone, review property data for locally-ownedproperty (county ormunicipality) within the flood zone and note. If parcel data is
available, deternine if anyproperty in the floodzone isgovemmentowned.
THE PROJECT ROW LIMITS OCCUR WITHIN THE 100-YEAR FLOODPLAIN. THERE ARE NO FEMA
BUYOUT PROPERTIES WITHIN THE VICINITY OF THE PROJECT.
28
Does the project include a de minimis or programmatic Section 4(f)?
This question will require additional evaluation during projectdeveloprrent. Referto Question#6 above.
SEE #6 ABOVE
29
Is the project considered a Type I under the NCDOTs Noise Policy?
Review NCDOT's Traffic Noise Policy (pages 2-3) to detemine the level of noise analysis that may be required. Provide responses for
each funding scenario noting the level of environmental documentation.
IF THE PROJECT IS FEDERALLY FUNDED
Is the project Type /project?
NO
IF THE PROJECT IS STATE FUNDED
is the plojeci oil an oautsiate oriuh cujiboi of access US route and does it involve adding additional through lanes? wll the project
require a state EA orEIS?
THE PROJECT IS NOT ON AN INTERSTATE OR FULL CONTROL OF ACCESS US ROUTE.
30 Is there prime or important farmland soil impacted by this project as defined by the Farmland Protection
Policy Act (FPPA)?
77

NCDOT Feasibility Studies Unit Bridge 850318 ti a
This question will be evaluated during project development.
N/A
31
Are there other issues that may affect project decisions?
Note any otherissues that shouldbe considered during projectdevelopment.
NO
INSTRUCTIONS: The following questions are basedon the CE Checklist for TYPE Ill projects. Answereach question in the space provided
based on available data. Include qualitative discussion as appropriate.
32 Is a project -level analysis for direct, indirect, or cumulative effects required based on the NCDOTcomm unity
studies screening tool?
This question will be evaluatedduring project development.
N/A
33 Is a project level air quality Mobile Source Air Toxics (MSAT) analysis required?
Note if existing or -
NO
ectedtraftic volunes on the project are greater -than 140,000 vpd.

NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
STRUCTURES MANAGEMENT UNIT — 5 YEAR BRIDGE PROGRAM
PRE-SCREENING SUMMARY
2023 SMU Bridge Program — Pre -Screening Worksheet
STIP #: BR-0123 I Bridge #:850318 BUILD Grant I Div./County: 11/Surry
Project Description: Bridge on SR 1319 over UT of South Fork Mitchell River
PRE-SCREENING DETERMINATION
Anticipated Project Development Duration: Potential 2-year project delivery to Letting.
Specific constraints/issues affecting duration: Off -site detour feasible, via SR 1320, SR 1301
and Oscar Callaway Road. Existing bridge is located immediately adjacent to the
intersection with Oscar Callaway Road. In addition to replace -in -place with off -site
detour, realignment of bridge and intersection should be evaluated.
General Project Context: see attached preliminar Study Area Ma
Existing typical section: Two lane shoulder
Facility classification: Local, Rural
Posted speed: Unknown — SR 1319 is a dirt
road with sharp turns.
Existing right-of-way (est.): 60' via GIS
Adjacent properties: Agricultural fields in all four quadrants.
Existing improvements proximate to project: Nothing observable via Google maps.
Surrounding community: Sparsely populated rural farms.
Topography: Flat plain between mountains
Current ADT / Source: No traffic counts available
Utilities observed: No utilities observed or identified. Unable to observe using Google
Maps or Google Earth.
Other concerns: This bridge is posted at 23 tons for single vehicle and 31 tons for TTST.
NEPA /SEPA Planning: (see Environmental Pre -Screening Checklist)
Cultural Resource: ETRACS request submitted: Responses pending
Natural Resource: No known occurrence of T&E species in study area. T&E species listed
for Surry County include Bog turtle, Northern long-eared bat, Rusty -patched bumble
bee
FERC Permit: No
Coast Guard Permit: No
Community Impacts: In Progress
8/30/2018

Other Concerns: N/A
Hydrologic / Hydraulic Assessment:
River/Stream Crossing: Yes
I Name: Toms Creek
FEMA Regulated: Yes
FEMA Model Type: Limited Detail - Available
River Basin: Yadkin Pee -Dee
I Buffers: None
WATER QUALITY DWR Surface Water Classification Map): indicate all that apply
H W: No
ORW: No
Trout: No
WSWS: No
Name: N/A
Critical Area: No
Other Concerns: N/A
I Division Consultation: (see attached worksheet)
General Summary:
Specific Utilities Considerations:
Other Concerns:
Utility Section Consultation:
Major Utilities Considerations: None
Other Concerns:
8/30/2018

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