19990094 Ver 1_Complete File_19990208

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
1kT?W'J
'946,02
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
February 8, 1999
M.C. Shaffner
NC DOT
2125 Cloverdale Avenue
Winston-Salem, NC 27103

336, ,- _? ( I-- ?;9l0
Dear Mr. Shaffner:
Subject: SR 1509
DWQ # 990094
Stokes County
On February 8, 1999, your application for a 401 Water Quality Certification for
paving SR 1509 in Stokes County was received by the N.C. Division of Water Quality.
The Division will begin to review the project for eventual decision. However, please be
aware that beginning January 1, 1999 that the N.C. General Assembly passed legislation
requiring payment of a fee of $200.00 for this project. The 401 Certification cannot be
issued until this fee is paid. Presently the Department of Transportation and Environment
and Natural Resources are developing a process so these fees will not have to be paid
separately for each project. We anticipate that this agreement will be finalized early in
1999. However until this agreement is completed we will not be able to complete our
action on your request. Until that time, your application will remain on hold as
incomplete.
Please call Cyndi Bell at 919-733-1786 if you have any questions.
1 c 2e,
J n R. Domey
cc: Central Files
Winston-Salem DWQ Regional Office
Raleigh Field Office US Army Corps of Engineers
Cyndi Bell
John Dorney
Wetlands/401 Unit 4401 Reedy Creek Road Raleigh, North Carolina 27607
Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer 50177 recycled/10% post consumer parer
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
A74
AWN" "nso-oftimeopm
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
February 8, 1999
M.C. Shaffner
NC DOT
2125 Cloverdale Avenue
Winston-Salem, NC 27103
Dear Mr. Shaffner:
Subject: SR 1217
DWQ # 990096
Stokes County
On February 8, 1999, your application for a 401 Water Quality Certification for
paving SR 1217 in Stokes County was received by the N.C. Division of Water Quality.
The Division will begin to review the project for eventual decision. However, please be
aware that beginning January 1, 1999 that the N.C. General Assembly passed legislation
requiring payment of a fee of $200.00 for this project. The 401 Certification cannot be
issued until this fee is paid. Presently the Department of Transportation and Environment
and Natural Resources are developing a process so these fees will not have to be paid
separately for each project. We anticipate that this agreement will be finalized early in
1999. However until this agreement is completed we will not be able to complete our
action on your request. Until that time, your application will remain on hold as
incomplete.
Please call Cyndi Bell at 919-733-1786 if you have any questions.
in e el
o n R. Do ey
cc: Central Files
Winston-Salem DWQ Regional Office
Raleigh Field Office US Army Corps of Engineers
Cyndi Bell
John Dorney
Wetlands/401 Unit 4401 Reedy Creek Road Raleigh, North Carolina 27607
Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
LT:!;WA
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
February 8, 1999
Mr. M.C. Shaffner
NC Department of Transportation
2125 Cloverdale Avenue
Winston-Salem, NC 27103
Dear Mr. Shaffner:
Subject: SR 1417
DWQ # 990097
Stokes County
On February 8, 1999, your application for a 401 Water Quality Certification for
paving SR 1417 in Stokes County was received by the N.C. Division of Water Quality.
The Division will begin to review the project for eventual decision. However, please be
aware that beginning January 1, 1999 that the N.C. General Assembly passed legislation
requiring payment of a fee of $200.00 for this project. The 401 Certification cannot be
issued until this fee is paid. Presently the Department of Transportation and Environment
and Natural Resources are developing a process so these fees will not have to be paid
separately for each project. We anticipate that this agreement will be finalized early in
1999. However until this agreement is completed we will not be able to complete our
action on your request. Until that time, your application will remain on hold as
incomplete.
Please call Cyndi Bell at 919-733-1786 if you have any questions.
Si *Domey
o n R. cc: Central Files
Winston-Salem DWQ Regional Office
Raleigh Field Office US Army Corps of Engineers
Cyndi Bell
John Dorney
Wetlands/401 Unit 4401 Reedy Creek Road Raleigh, North Carolina 27607
Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
A94"o 0
100" ftW00x=%ftW00M.V
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
February 8, 1999
M.C. Shaffner
NC DOT
2125 Cloverdale Avenue
Winston-Salem, NC 27103
Dear Mr. Shaffner:
Subject: SR 1509
DWQ # 990094
Stokes County
On February 8, 1999, your application for a 401 Water Quality Certification for
paving SR 1509 in Stokes County was received by the N.C. Division of Water Quality.
The Division will begin to review the project for eventual decision. However, please be
aware that beginning January 1, 1999 that the N.C. General Assembly passed legislation
requiring payment of a fee of $200.00 for this project. The 401 Certification cannot be
issued until this fee is paid. Presently the Department of Transportation and Environment
and Natural Resources are developing a process so these fees will not have to be paid
separately for each project. We anticipate that this agreement will be finalized early in
1999. However until this agreement is completed we will not be able to complete our
action on your request. Until that time, your application will remain on hold as
incomplete.
Please call Cyndi Bell at 919-733-1786 if you have any questions.
1 c el
J n R. Domey
cc: Central Files
Winston-Salem DWQ Regional Office
Raleigh Field Office US Army Corps of Engineers
Cyndi Bell
John Dorney
Wetlands/401 Unit 4401 Reedy Creek Road Raleigh, North Carolina 27607
Telephone [phone] FAX # [phone]
An Equ. vppor,..,,.(y

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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
JAMES B. HUNT JR.
GOVERNOR
February 4, 1999
Stokes County - SR 1509
DIVISION OF HIGHWAYS
SUBJECT: Drainage Permits - Division of Water Quality
Mr. John Dorney Attn: Cindy Bell
Water Quality Planning
Division of Water Quality
NC DEHNR
4401 Reedy Creek Road
Raleigh, NC 27607
Dear Cindy Bell,
E. NORRIS TOLSON
SECRETARY
i
g 1999
FEB
+°' ;lt ?I?+JS GROUP
In an effort to obtain the necessary drainage permits, we are providing a package of design plans
for the paving of John Tucker Road (SR 1509) in Stokes County. In order to pave John Tucker Road it
will be necessary to replace, add, and/or extend the drainage pipes on this road.
By copy of this letter, we are also seeking approval from the NC Wildlife Resources Commission
as well as the US Army Corps of Engineer, therefore we are submitting the enclosed material to them.
If you have any questions, comments or need additional information after reviewing this material,
please contact our office at [phone]. Thank you for your cooperation in this matter.
3s6
Respectfully,
}
C.
?? GW LA
M.C. Shaffner
District Engineer
MCS:Iaj
Enclosures
c: Mr. D.B. Waters, Division Engineer
Mr. David Spainhour, Stokes County Maintenance Engineer
File
Division of Highways • Division Nine • District Two • 2125 Cloverdale Avenue, Winston-Salem, NC 27103
Telephone [phone] • Fax [phone] • Courier Box 13-12-04
DEM ID:
CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT 4):
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7)
COPIES SHOULD BE SENT TO THE N. C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME: NC DEPARTMENT OF TRANSPORTATION
2. MAILING ADDRESS
CITY: WINSTON-SALEM
2125 CLOVERDALE AVENUE
SUBDIVISION NAME
STATE: NC ZIP CODE:
27103
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER (HOME):
(WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICAL, ADDRESS,
PHONE: M.C SHAFFNER
2125 CLOVERDALE AVENUE
WINSTON-SALEM, NC 27103 [phone]
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: STOKES
NEAREST TOWN OR CITY: LAWSONVILLE
SPECIFIC LOCATION (INCLUDING ROAD NUMBERS, LANDMARKS,
FROM LAWSONVILLE NC TAKE SR 1497 N.WEST FOR APPROX 4 MILES SR 1509 ON RIGHT.
6. IMPACTED OR NEAREST STREAM/RIVER: DAN RIVER
RIVER BASIN: ROANOKE RIVER BASIN
I
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER (SA),
HIGH QYALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ® NO ? IF YES, EXPLAIN: OUR PROJECT IS
WITHIN A WATER SUPPLY WATERSHED PROTECTED AREA.
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? N/A
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES ? NO ® IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ? NO ® IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: N/A
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
N/A
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
N/A
FILLING: 0
FLOODING: 0
DRAINAGE: 0
EXCAVATION: 0
OTHER: 0
TOTAL ACRES TO BE IMPACTED: 0
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IFRELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT. AFTER: _
WIDTH BEFORE (based on normal high water contours):
WIDTH AFTER: FT.
AVERAGE DEPTH BEFORE: FT. AFTER:
FT.
FT.
FT.
2
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION ? PLACEMENT OF PIPE IN CHANNEL ?
CHANNEL EXCAVATION ? CONSTRUCTION OF A DAM/FLOODING ?
11
OTHER ? EXPLAIN:
IF CONTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 1I" DRAWINGS
ONLY): GRADE, BASE, PAVE JOHN TUCKER ROAD (SR 1509) IN STOKES COUNTY.
13. PURPOSE OF PROPOSED WORK: TO IMPROVE ROAD CONDITIOINS
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT
IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS): THIS ROAD WILL BE STABILIZED IN THE UPCOMING MONTHS
(FISCAL YEAR 1999-2000) BECAUSE OF SAFETY FACTORS. THE CAREFUL WORK OF
THE NCDOT FORCES WILL NIINIMIZE IMPACTS TO WETLAND AND/OR TROUT
STREAMS.
15. YOU ARE REQUIRED TO CONTACT THE U. S. FISH AND WILDLIFE SERVICE (USFWS)
AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES
SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR
LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE
PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED
AGENCIES.)
02-04-99
(ATTACH RESPONSES FROM THESE
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED: 02-04-99
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES ? NO ® (IF NO, GO TO 18)
3
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT?
YES ? NO ?
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES ? NO ?
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT
REGARDING COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY
ACT.
Q UESTIONS REGARDING THE STAE CLEARINGHO USE REVIEW PROCESS SHO ULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHO USE, NORTH
CAROLINA DEPARTMENT OFADMINISTRATION, 116 WEST JONES STREED, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OR 1 INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND US OF SURROUNDING PROPERTY? N/A
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? N/A
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
4
NOTE: WETLANDS OR WATERS OF THE US . MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OFA SECTON 404 CORPS OF ENGINEERS PERMIT,
2. EITHER THE ISSUANCE OR WAILER OFA 401 DIVISION OF ENVIRONMENTAL
MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED ACTIVITY IS
CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT PROGRAM.

OWNER'S/AGENT SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY IF AUTHORIZATION I ETTER FROM THE OWNER IS PROVIDED (18g))
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PROPOSED DRAINAGE CROSS LINE TREATMENT
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LOCATED: FROM LAWSONVILLE NC, TAKE SR 1497 N WEST FOR APPROX 4 MILES, SR 1509
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DEM ID:
CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) :
a
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7)
COPIES SHOULD BE SENT TO THE N. C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME: NC DEPARTMENT OF TRANSPORTATION
2. MAILING ADDRESS: 2125 CLOVERDALE AVENUE
SUBDIVISION NAME
CITY: WINSTON-SALEM STATE: NC ZIP CODE:
27103
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER (HOME): (WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICAL. ADDRESS.
PHONE: M.C SHAFFNER
2125 CLOVERDALE AVENUE
WINSTON-SALEM. NC 27103 [phone]
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: STOKES NEAREST TOWN OR CITY: LAWSONVILLE
SPECIFIC LOCATION (INCLUDING ROAD NUMBERS, LANDMARKS,
FROM LAWSONVILLE NC. TAKE SR 1497 N. WEST FOR APPROX 4 MILES. SR 1509 ON RIGHT.
6. IMPACTED OR NEAREST STREAM/RIVER: DAN RIVER
RIVER BASIN: ROANOKE RIVER BASIN
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER (SA),
HIGH QYALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ® NO ? IF YES, EXPLAIN: OUR PROJECT IS
WITHIN A WATER SUPPLY WATERSHED PROTECTED AREA
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? N/A
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES ? NO ® IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ? NO ® IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: N/A
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
N/A
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
N/A
FILLING: 0 EXCAVATION: 0
FLOODING: 0 OTHER: 0
DRAINAGE: 0 TOTAL ACRES TO BE IMPACTED: 0
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IFRELOCATED,
PROT17DE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT. AFTER: _
WIDTH BEFORE (based on normal high water contours):
WIDTH AFTER: FT.
AVERAGE DEPTH BEFORE: FT. AFTER:
FT.
FT.
FT.
2
(2) STREAM CHANNEL PACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION ? PLACEMENT OF PIPE IN CHANNEL ?
CHANNEL EXCAVATION ? CONSTRUCTION OF A DAM/FLOODING ?
11
OTHER ? EXPLAIN:
IF CONTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
WHAT IS THE E)G%CTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY): GRADE, BASE, PAVE JOHN TUCKER ROAD (SR 1509) IN STOKES COUNTY.
13. PURPOSE OF PROPOSED WORK: TO IMPROVE ROAD CONDITIOINS
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT
IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIIVIIZ,E WETLAND
IMPACTS): THIS ROAD WILL BE STABILIZED IN THE UPCOMING MONTHS
(FISCAL YEAR 1999-2000) BECAUSE OF SAFETY FACTORS. THE CAREFUL WORK OF
THE NCDOT FORCES WILL MQNI IIZE IMPACTS TO WETLAND AND/OR TROUT
STREAMS.
15. YOU ARE REQUIRED TO CONTACT THE U. S. FISH AND WILDLIFE SERVICE (USFWS)
AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES
SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR
LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE
PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED:
AGENCIES.)
02-04-99
(ATTACH RESPONSES FROM THESE
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED: 02-04-99
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES ? NO ® (IF NO, GO TO 18)
3
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT?
YES ? NO ?
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES ? NO ?
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT
REGARDING COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY
ACT.
QUESTIONS REGARDING THE STAE CLEARINGHOUSE RENEW PROCESS SHOULD BE
DIRECTED TO MS CHRYS BAGGE7T, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OFADMINISTRATION, 116 WEST JONES STREED, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OR 1 INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED,
e. WHAT IS LAND US OF SURROUNDING PROPERTY? N/A
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? N/A
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
4
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OFA SECTON 404 CORPS OF ENGINEERS PERMIT,
2. EITHER THE ISSUANCE OR WAIVER OFA 401 DIVISION OF ENVIRONMENTAL
MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONL)), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED ACTIVITY IS
CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT PROGRAM.
-?J
E?-
OWNER'S/AGENT SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY IF AUTHORIZATION LETTER FROM THE OWNER IS PROVIDED (18g.))
6
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1630 000 FEET (N. C.) 56
30 ROAD CLASSIFICATION
1 MILE
Primary highway, all weather, Light-duty road, all v
4000 5000 6000 7000 FEET hard surface ........_.............. improved surface.........:
1 KILOMETER Secondary highway, all weather, Unimproved road, fa
hard surface ........... ............. . weather...............................
20 FEET N State Route
DATUM OF 1929 /"l
PROPOSED DRAINAGE CROSS LINE TREATMENT
ALONG:JOHN TUCKER ROAD SR:1509, STOKES COUNTY
LOCATED: FROM LAWSONVILLE NC, TAKE SR 1497 N WEST FOR APPROX 4 MILES, SR 1509
OTT RTr_uT

STATION EXISTING
DESCRIPTION
LGTH/DIAM/TYPE REPLACEMENT
DESCRIPTION
LGTH/DIAM/TYPE
SECTION TYPE
LEFT/RIGHT

COVER
SKEW
(APPROX)
14+50 32'-18"RCP 44'-18"RCP FILL/FILL MIN 1' 90°
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28+50 32'-18"RCP 441-18"RCP FILL/FILL MIN 1' 90°
34+00 281-18"RCP 40'-18"RCP FILL/FILL MIN 1' 90°
42+00 32'-18"RCP 40'-18"RCP FILL/FILL MIN.1' 90°
60+50 NONE 40'-18"RCP FILL/FILL MIN 1' 9 0°

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DEM ID:
CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) :
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7)
COPIES SHOULD BE SENT TO THE N. C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME: NC DEPARTMENT OF TRANSPORTATION
2. MAILING ADDRESS: 2125 CLOVERDALE AVENUE
SUBDIVISION NAME
CITY: WINSTON-SALEM STATE: NC ZIP CODE: 27103
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER (HOME):
(WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICAL, ADDRESS,
PHONE: M.C SHAFFNER
2125 CLOVERDALE AVENUE
WINSTON-SALEM, NC 27103 [phone]
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: STOKES
NEAREST TOWN OR CITY: LAWSONVILLE
SPECIFIC LOCATION (INCLUDING ROAD NUMBERS, LANDMARKS,
FROM LAWSONVILLE NC. TAKE SR 1497 N. WEST FOR APPROX 4 MILES, SR 1509 ON RIGHT.
6. IMPACTED OR NEAREST STREAM/RIVER: DAN RIVER
RIVER BASIN: ROANOKE RIVER BASIN
1
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER (SA),
HIGH QYALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ® NO ? IF YES, EXPLAIN: OUR PROJECT IS
WITHIN A WATER SUPPLY WATERSHED PROTECTED AREA.
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? N/A
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES ? NO ® IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ? NO ® IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: N/A
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
N/A
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
N/A
FILLING: 0 EXCAVATION: 0
FLOODING: 0 OTHER: 0
DRAINAGE: 0 TOTAL ACRES TO BE IMPACTED: 0
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IFRELOCATED,
PRO 117DE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT. AFTER: _
WIDTH BEFORE (based on normal high water contours):
WIDTH AFTER: FT.
AVERAGE DEPTH BEFORE: FT. AFTER:
FT.
FT.
FT.
2
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION ? PLACEMENT OF PIPE IN CHANNEL ?
CHANNEL EXCAVATION ? CONSTRUCTION OF A DAM/FLOODING ?
a
11
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
OTHER ? EXPLAIN:
IF CONTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
WHAT IS THE EXPECTED POND SURFACE AREA?
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY): GRADE, BASE. PAVE JOHN TUCKER ROAD (SR 1509) IN STOKES COUNTY.
13. PURPOSE OF PROPOSED WORK: TO IMPROVE ROAD CONDITTOTNS
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED: 02-04-99
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT
IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
RvIPACTS): THIS ROAD WILL BE STABILIZED IN THE UPCOMING MONTHS
(FISCAL YEAR 1999-2000) BECAUSE OF SAFETY FACTORS. THE CAREFUL WORK OF
THE NCDOT FORCES WILL MINIMIZE IMPACTS TO WETLAND AND/OR TROUT
STREAMS.
15. YOU ARE REQUIRED TO CONTACT THE U. S. FISH AND WILDLIFE SERVICE (USFWS)
AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES
SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR
LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE
PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED:
AGENCIES.)
02-04-99
(ATTACH RESPONSES FROM THESE
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
17. DOES, THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES ? NO ® (IF NO, GO TO 18)
3
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT?
YES[-] NO[]
a b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES ? NO ?
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT
REGARDING COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY
ACT.
Q UESTIONS REGARDING THE STAE CLEARINGHOUSE RET17EW PROCESS SHO ULD BE
DIRECTED TO MS. CHRYS BAGGETT,, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OFADMINISTRATION, 116 WEST .ZONES STREED, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OR 1 INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND US OF SURROUNDING PROPERTY? N/A
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? N/A
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
4
NOTE. WETLANDS OR WATERS OF THE US . MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OFA SECTON 404 CORPS OF ENGINEERS PERMFT,
2. EITHER THE ISSUANCE OR WAIVER OFA 401 DIVISION OF ENVIRONMENTAL
MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED ACTIVITY IS
CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGELIENT PROGRAM.
LAd
OWNER'S/AGENT SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY IF AUTHORIZATION LETTER FROM THE OWNER IS PROVIDED (18g.))
6
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CK) 562 563 17'3011 564 565 INTERIOR-GEOLO G ICAL •S U RVEV. RESTbN. VIRGINIA-19
1 630000 FEET (N. C.) 56
00
1 MILE ROAD CLASSIFICATION
Primary highway, all weather, Light-duty road, all N
aooo 500o eooo ?ooo FEET hard surface .......... improved surface..........:
1 KILOMETER Secondary highway, all weather, Unimproved road, fE
hard surface ........................: weather_......................
.......
_ 20 FEET
DATUM OF 1929 /"L 0 State Route
PROPOSED DRAINAGE CROSS LINE TREATMENT
ALONG:JOHN TUCKER ROAD SR:1509, STOKES COUNTY
LOCATED: FROM LAWSONVILLE NC, TAKE SR 1497 N WEST FOR APPROX 4 MILES, SR 1509
ON RIGHT.

STATION EXISTING
DESCRIPTION
LGTH/DIAM/TYPE REPLACEMENT
DESCRIPTION
LGTH/DIAM/TYPE
SECTION TYPE
LEFT/RIGHT

COVER
SKEW
(APPROX)
14+50 32'-18"RCP 44'-18"RCP FILL/FILL MIN 1' 90°
17+50 32'-18"RCP 44'-18"RCP FILL/FILL MIN 1' 90°
28+50 32'-18"RCP 44'-18"RCP FILL/FILL MIN 1' 90°
34+00 28'-18"RCP 40'-18"RCP FILL/FILL MIN 1' 90°
42+00 32' -18"RCP 40' -18"RCP FILL/FILL MIN .1' 90°
60+50 NONE 40'-18"RCP FILL/FILL MIN 1' 90°

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DEM ID:
CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) :
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7)
COPIES SHOULD BE SENT TO THE N. C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME: NC DEPARTMENT OF TRANSPORTATION
2. MAILING ADDRESS: 2125 CLOVERDALE AVENUE
SUBDIVISION NAME
CITY: WINSTON-SALEM STATE: NC ZIP CODE: 27103
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER (HOME):
(WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICAL, ADDRESS.
PHONE: M.C SHAFFNER
2125 CLOVERDALE AVENUE
WINSTON-SALEM. NC 27103 [phone]
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: STOKES
NEAREST TOWN OR CITY: LAWSONVILLE
SPECIFIC LOCATION (INCLUDING ROAD NUMBERS, LANDMARKS,
FROM LAWSONVILLE NC. TAKE SR 1497 N.WEST FOR APPROX 4 MILES, SR 1509 ON RIGHT.
6. IMPACTED OR NEAREST STREAM/RIVER: DAN RIVER
RIVER BASIN: ROANOKE RIVER BASIN
1
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER (SA),
HIGH QYALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ® NO ? IF YES, EXPLAIN: OUR PROJECT IS
WITHIN A WATER SUPPLY WATERSHED PROTECTED AREA.
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? N/A
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES ? NO ® IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ? NO ® IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: N/A
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
N/A
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
N/A
FILLING: 0 EXCAVATION: 0
FLOODING: 0 OTHER: 0
DRAINAGE: 0 TOTAL ACRES TO BE IMPACTED: 0
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IFRELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT. AFTER: FT.
WIDTH BEFORE (based on normal high water contours): FT.
WIDTH AFTER: FT.
AVERAGE DEPTH BEFORE: FT. AFTER: FT.
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION ? PLACEMENT OF PIPE IN CHANNEL ?
CHANNEL EXCAVATION ? CONSTRUCTION OF A DAM/FLOODING ?
OTHER ? EXPLAIN:
11. IF CONTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 1 P' DRAWINGS
ONLY): GRADE, BASE, PAVE JOHN TUCKER ROAD (SR 1509) IN STOKES COUNTY.
13. PURPOSE OF PROPOSED WORK: TO IMPROVE ROAD CONDITIOINS
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT
IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS): THIS ROAD WILL BE STABILIZED IN THE UPCOMING MONTHS
(FISCAL YEAR 1999-2000) BECAUSE OF SAFETY FACTORS. THE CAREFUL WORK OF
THE NCDOT FORCES WILL MINIlVIIZE IMPACTS TO WETLAND AND/OR TROUT
STREAMS.
15. YOU ARE REQUIRED TO CONTACT THE U. S. FISH AND WILDLIFE SERVICE (USFWS)
AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES
SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR
LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE
PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED
AGENCIES.)
02-04-99
(ATTACH RESPONSES FROM THESE
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED: 02-04-99
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES ? NO ® (IF NO, GO TO 18)
3
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT?
YES ? NO ?
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES ? NO ?
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT
REGARDING COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY
ACT.
Q UESTIONS REGARDING THE STAE CLEARINGHO USE REVIEW PROCESS SHO ULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OFADMINISTRATION, 116 WEST JONES STREED, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OR 1 INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
HAPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT. INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND US OF SURROUNDING PROPERTY? N/A
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? N/A
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER. IF APPLICABLE.
4
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OFA SECTON 404 CORPS OF ENGINEERS PERMIT,
d 2. EITHER THE ISSUANCE OR WAIVER OFA 401 DIVISION OF ENVIRONMENTAL
MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED ACTIVITY IS
CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT PROGRAM.

OWNER'S/AGENT SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY IF AUTHORIZATION LETTER FROM THE OWNER IS PROVIDED (I 8g.))
6
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-K) v 562 I - 5V63 17'30' 564 565 61 INTERIOR-GEOLOGICAL SURVEY.RESTON. VIRGINIA-191
1630 000 FEET (N. C.) 5E
)0
1 MILE ROAD CLASSIFICATION
Primary highway, all weather, Light-duty road, all v
4000 5000 6000 7000 FEET hard surface ......................... improved surface
........__
1 KILOMETER Secondary highway, all weather, Unimproved road, fa
hard surface .................. ._....: weather...................................
20 FEET
DATUM OF 1929 / L 0 State Route
PROPOSED DRAINAGE CROSS LINE TREATMENT
ALONG:JOHN TUCKER ROAD SR:1509, STOKES COUNTY
LOCATED: FROM LAWSONVILLE NC, TAKE SR 1497 N WEST FOR APPROX 4 MILES, SR 1509
ON RIGHT.

STATION EXISTING
DESCRIPTION
LGTH/DIAM/TYPE REPLACEMENT
DESCRIPTION
LGTH/DIAM/TYPE
SECTION TYPE
LEFT/RIGHT

COVER
SKEW
(APPROX)
14+50 32'-18"RCP 44'-18"RCP FILL/FILL MIN 1' 90°
17+50 32'-18"RCP 44'-18"RCP FILL/FILL MIN 1' 90°
28+50 32'-18"RCP 44'-18"RCP FILL/FILL MIN 1' 90°
34+00 28'-18"RCP 401-18"RCP FILL/FILL MIN 1' 90°
42+00 32'-18"RCP 40'-18"RCP FILL/FILL MIN.1' 90°
60+50 NONE 40'-18"RCP FILL/FILL MIN 1' 90°

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DEM ID:
CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) :
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7)
COPIES SHOULD BE SENT TO THE N. C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME: NC DEPARTMENT OF TRANSPORTATION
2. MAILING ADDRESS: 2125 CLOVERDALE AVENUE
SUBDIVISION NAME
CITY: WINSTON-SALEM STATE: NC
ZIP CODE: 27103
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER (HOME):
(WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICAL, ADDRESS,
PHONE: M.C SHAFFNER
2125 CLOVERDALE AVENUE
WINSTON-SALEM. NC 27103 [phone]
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: STOKES
NEAREST TOWN OR CITY: LAWSONVILLE
SPECIFIC LOCATION (INCLUDING ROAD NUMBERS, LANDMARKS,
FROM LAWSONVILLE NC. TAKE SR 1497 N. WEST FOR APPROX 4 MILES. SR 1509 ON RIGHT.
6. IMPACTED OR NEAREST STREAM/RIVER: DAN RIVER
RIVER BASIN: ROANOKE RIVER BASIN
1
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER (SA),
HIGH QYALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ® NO ? IF YES, EXPLAIN: OUR PROJECT IS
WITHIN A WATER SUPPLY WATERSHED PROTECTED AREA
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? N/A
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES ? NO ® IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ? NO ® IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: N/A
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
N/A
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
N/A
FILLING: 0
FLOODING:
DRAINAGE:
0
0
EXCAVATION: 0
OTHER: 0
TOTAL ACRES TO BE IMPACTED: 0
. 10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IFRELOCATED,
PRO FIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT. AFTER: _
WIDTH BEFORE (based on normal high water contours):
WIDTH AFTER: FT.
AVERAGE DEPTH BEFORE: FT. AFTER:
FT.
FT.
FT.
2
? Y
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION ? PLACEMENT OF PIPE IN CHANNEL ?
CHANNEL EXCAVATION ? CONSTRUCTION OF A DAM/FLOODING ?
OTHER ? EXPLAIN:
11. IF CONTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY): GRADE, BASE, PAVE JOHN TUCKER ROAD (SR 1509) IN STOKES COUNTY.
13. PURPOSE OF PROPOSED WORK: TO IMPROVE ROAD CONDITIOINS
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT
IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS): THIS ROAD WILL BE STABILIZED IN THE UPCOMING MONTHS
(FISCAL YEAR 1999-2000) BECAUSE OF SAFETY FACTORS. THE CAREFUL WORK OF
THE NCDOT FORCES WILL NIINIlVIIZE IMPACTS TO WETLAND AND/OR TROUT
STREAMS.
15. YOU ARE REQUIRED TO CONTACT THE U. S. FISH AND WILDLIFE SERVICE (USFWS)
AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES
SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR
LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE
PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED:
AGENCIES.)
02-04-99
(ATTACH RESPONSES FROM THESE
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED: 02-04-99
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES ? NO ® (IF NO, GO TO 18)
3
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
j DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT?
YES ? NO ?
e b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH
CAROLINA DEPARTMENT OF ADM STISTRATION STATE CLEARINGHOUSE?
YES ? NO ?
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT
REGARDING COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY
ACT.
O UESTIONS REGARDING THE STAE CLEARINGHO USE REVIEW PROCESS SHO ULD BE
DIRECTED TO MS. CHRYS BAGGE7T, DIRECTOR STATE CLEARINGHO USE, NORTH
CAROLINA DEPARTMENT OFADMINISTRATION, 116 WEST JONES STREED, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OR 1 INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
RvIPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND US OF SURROUNDING PROPERTY? N/A
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? N/A
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
4
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OFA SECTON 404 CORPS OF ENGINEERS PERMIT,
2. EITHER THE ISSUANCE OR WAIVER OFA 401 DIVISION OF ENVIRONMENTAL
MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIUISION OF COASTAL MANAGE1L1ENT STATING THE PROPOSED ACTIVITY IS
CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT PROGRAM.

I L,4 (f 2 -y-
OWNER'S/AGENT SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY IF AUTHORIZATION LETTER FROM THE OWNER IS PROVIDED (IS&))
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V 1630 000 FEET (N. C.) 56
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1 MICE ROAD CLASSIFICATION
Primary highway, all weather, Light-duty road, all u
4000 5000 6000 7000 FEET hard surface ......................... improved surface.........,
1 KILOMETER Secondary highway, all weather, Unimproved road, fz
hard surface............ ............. weather...............................
..
20 FEET
DATUM OF 1929 / 0 State Route
PROPOSED DRAINAGE CROSS LINE TREATMENT
ALONG:JOHN TUCKER ROAD SR:1509, STOKES COUNTY
LOCATED: FROM LAWSONVILLE NC, TAKE SR 1497 N WEST FOR APPROX 4 MILES, SR 1509
ON RIGHT.

STATION EXISTING
DESCRIPTION
LGTH/DIAM/TYPE REPLACEMENT
DESCRIPTION
LGTH/DIAM/TYPE
SECTION TYPE
LEFT/RIGHT

COVER
SKEW
(APPROX)
14+50 32'-18"RCP 44'-18"RCP FILL/FILL MIN 1' 90°
17+50 32'-18"RCP 44'-18"RCP FILL/FILL MIN 1' 90°
28+50 32'-18"RCP 44'-18"RCP FILL/FILL MIN 1' 90°
34+00 28'-18"RCP 40'-18"RCP FILL/FILL MIN 1' 90°
42+00 32'-18"RCP 40'-18"RCP FILL/FILL MIN.1' 90°
60+50 NONE 40'-18"RCP FILL/FILL MIN 1' 90°

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DEM ID:
CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) :
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7)
COPIES SHOULD BE SENT TO THE N. C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME: NC DEPARTMENT OF TRANSPORTATION
2. MAILING ADDRESS: 2125 CLOVERDALE AVENUE
SUBDIVISION NAME
CITY: WINSTON-SALEM STATE: NC ZIP CODE: 27103
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER (HOME):
(WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICAL, ADDRESS,
PHONE: M.C SHAFFNER
2125 CLOVERDALE AVENUE
WINSTON-SALEM. NC 27103 [phone]
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: STOKES
NEAREST TOWN OR CITY: LAWSONVILLE
SPECIFIC LOCATION (INCLUDING ROAD NUMBERS. LANDMARKS,
FROM LAWSONVILLE NC. TAKE SR 1497 N. WEST FOR APPROX 4 MILES. SR 1509 ON RIGHT.
6. IMPACTED OR NEAREST STREAM/RIVER: DAN RIVER
RIVER BASIN: ROANOKE RIVER BASIN
I
• 4
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER (SA),
HIGH QYALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ® NO ? IF YES, EXPLAIN: OUR PROJECT IS
WITHIN A WATER SUPPLY WATERSHED PROTECTED AREA.
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? N/A
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES ? NO ® IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ? NO ® IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: N/A
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
N/A
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
N/A
FILLING: 0 EXCAVATION: 0
FLOODING: 0 OTHER: 0
DRAINAGE: 0 TOTAL ACRES TO BE IMPACTED
0
lob. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IFRELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT. AFTER: _
WIDTH BEFORE (based on normal high water contours):
WIDTH AFTER: FT.
AVERAGE DEPTH BEFORE: FT. AFTER:
FT.
FT.
FT.
2
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION ? PLACEMENT OF PIPE IN CHANNEL ?
CHANNEL EXCAVATION ? CONSTRUCTION OF A DAM/FLOODING ?
OTHER ? EXPLAIN:
11. IF CONTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY): GRADE, BASE, PAVE JOHN TUCKER ROAD (SR 1509) IN STOKES COUNTY.
13. PURPOSE OF PROPOSED WORK: TO IMPROVE ROAD CONDITIOINS
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT
IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO M[NIMME WETLAND
IMPACTS): THIS ROAD WILL BE STABILIZED IN THE UPCOMING MONTHS
(FISCAL YEAR 1999-2000) BECAUSE OF SAFETY FACTORS. THE CAREFUL WORK OF
THE NCDOT FORCES WILL MININIIZE IMPACTS TO WETLAND AND/OR TROUT
STREAMS.
15. YOU ARE REQUIRED TO CONTACT THE U. S. FISH AND WILDLIFE SERVICE (USFWS)
AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES
SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR
LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE
PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED:
AGENCIES.)
02-04-99
(ATTACH RESPONSES FROM THESE
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED: 02-04-99
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES ? NO ® (IF NO, GO TO 18)
3
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT?
YES ? NO ?
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES ? NO ?
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT
REGARDING COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY
ACT.
O UESTIONS REGARDING THE STAE CLEARINGHOUSE RENEW PROCESS SHO ULD BE
DIRECTED TO MS. CHRYS BAGGE7T, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OFADMINISTRATION, 116 WEST JONES STREED, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS. STREAMS. LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OR 1 INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND US OF SURROUNDING PROPERTY? N/A
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? N/A
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
4
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OFA SECTON 404 CORPS OF ENGINEERS PERMIT,
D 2. EITHER THE ISSUANCE OR WAIVER OFA 401 DIVISION OF ENVIRONMENTAL
MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONL 19, A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED ACTIVITY IS
CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT PROGRAM.
L,4 (I
OWNER'S/AGENT SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY IF AUTHORIZATION LETTER FROM THE OWNER IS PROVIDED (18g,))
6
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'CKI 562 I - 563 1713011 564 565 INTERIOR-GEOLOGICAL SURVEY, RESTb N. VIRGINIA-19
1630000 FEET (N . C.) 56
1QQ
1 MILE ROAD CLASSIFICATION
Primary highway, all weather, Light-duty road, all 1
aooo 500o aooo 7000 FEET hard surface ........................ improved surface..........
1 KILOMETER Secondary highway, all weather, Unimproved road, fE
20 FEET hard surface .................. - weather.................................
_ DATUM OF 1929 / ` 0 State Route
PROPOSED DRAINAGE CROSS LINE TREATMENT
ALONG:JOHN TUCKER ROAD SR:1509, STOKES COUNTY
LOCATED: FROM LAWSONVILLE NC, TAKE SR 1497 N WEST FOR APPROX 4 MILES, SR 1509
()TT RT(ZTTT

STATION EXISTING
DESCRIPTION
LGTH/DIAM/TYPE REPLACEMENT
DESCRIPTION
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SECTION TYPE
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COVER
SKEW
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14+50 32'-18"RCP 44'-18"RCP FILL/FILL MIN 1' 90°
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28+50 32'-18"RCP 44'-18"RCP FILL/FILL MIN 1' 90°
34+00 281-18"RCP 40'-18"RCP FILL/FILL MIN 1' 90°
42+00 32'-18"RCP 40'-18"RCP FILL/FILL MIN.1' 90°
60+50 NONE 40'-18"RCP FILL/FILL MIN 1' 90°

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DEM ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) :
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7)
COPIES SHOULD BE SENT TO THE N. C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME: NC DEPARTMENT OF TRANSPORTATION
2. MAILING ADDRESS: 2125 CLOVERDALE AVENUE
SUBDIVISION NAME
CITY: WINSTON-SALEM STATE: NC
ZIP CODE: 27103
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER (HOME):
(WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICAL, ADDRESS,
PHONE: M.C SHAFFNER
2125 CLOVERDALE AVENUE
WINSTON-SALEM. NC 27103 [phone]
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: STOKES NEAREST TOWN OR CITY: LAWSONVILLE
SPECIFIC LOCATION (INCLUDING ROAD NUMBERS, LANDMARKS.
FROM LAWSONVILLE NC. TAKE SR 1497 N. WEST FOR APPROX 4 MILES, SR 1509 ON RIGHT.
6. IMPACTED OR NEAREST STREAM/RIVER: DAN RIVER
RIVER BASIN: ROANOKE RIVER BASIN
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER (SA),
HIGH QYALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ® NO ? IF YES. EXPLAIN: OUR PROJECT IS
WITHIN A WATER SUPPLY WATERSHED PROTECTED AREA.
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? N/A
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES ? NO ® IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ? NO ® IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: N/A
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
N/A
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
N/A
FILLING: 0 EXCAVATION: 0
FLOODING: 0 OTHER: 0
DRAINAGE: 0 TOTAL ACRES TO BE IMPACTED: 0
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IFRELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION) :
LENGTH BEFORE: FT. AFTER: _
WIDTH BEFORE (based on normal high water contours):
WIDTH AFTER: FT.
AVERAGE DEPTH BEFORE: FT. AFTER:
FT.
FT.
FT.
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION ? PLACEMENT OF PIPE IN CHANNEL ?
CHANNEL EXCAVATION ? CONSTRUCTION OF A DAM/FLOODING ?
11
OTHER ? EXPLAIN:
IF CONTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY): GRADE, BASE, PAVE JOHN TUCKER ROAD (SR 1509) IN STOKES COUNTY.
13. PURPOSE OF PROPOSED WORK: TO IMPROVE ROAD CONDITIOINS
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT
IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINMZE WETLAND
IMPACTS): THIS ROAD WILL BE STABILIZED IN THE UPCOMING MONTHS
(FISCAL YEAR 1999-2000) BECAUSE OF SAFETY FACTORS. THE CAREFUL WORK OF
THE NCDOT FORCES WILL MINIMIZE IMPACTS TO WETLAND AND/OR TROUT
STREAMS.
15. YOU ARE REQUIRED TO CONTACT THE U. S. FISH AND WILDLIFE SERVICE (USFWS)
AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES
SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR
LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE
PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED: 02-04-99 (ATTACH RESPONSES FROM THESE
AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED: 02-04-99
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES ? NO ® (IF NO, GO TO 18)
3
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT?
YES[:] NO ?
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES ? NO ?
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT
REGARDING COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY
ACT.
O UESTIONS REGARDING THE STAE CLEARINGHO USE REVIEW PROCESS SHO ULD BE
DIRECTED TO MS. CHRYS BAGGE7T, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OFADMINISTRATION, 116 WEST JONES STREED, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OR 1 INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND US OF SURROUNDING PROPERTY? N/A
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? N/A
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
4
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OF A SECTON 404 CORPS OF ENGINEERS PERMIT,
2. EITHER THE ISSUANCE OR WAIVER OFA 401 DIVISION OF ENT1IRONMENTAL
MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONE 19, A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED ACTIVITY IS
CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT PROGRAM.
4V
OWNER'S/AGENT SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY IF AUTHORIZATION LETTER FROM THE OWNER IS PROVIDED (18g.))
6
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CK) 562 1 563 17'30° 564 565 91 INTERIOR-GEOLOGICAL SURVEY. RESTPN. VIRGINIA-1S1
1630 000 FEET (N. C.) 56
00 MILE ROAD CLASSIFICATION
1
Primary highway, all weather, Light-duty road, all v
4000 5000 6000 7000 FEET hard surface ......................... improved surface........__
1 KILOMETER Secondary highway, all weather, Unimproved road, fa
hard surface .......................... weather...............................
20 FEET
DATUM OF 1929 /"l 0 State Route
PROPOSED DRAINAGE CROSS LINE TREATMENT
ALONG:JOHN TUCKER ROAD SR:1509, STOKES COUNTY
LOCATED: FROM LAWSONVILLE NC, TAKE SR 1497 N WEST FOR APPROX 4 MILES, SR 1509
ON RIGHT.

STATION EXISTING
DESCRIPTION
LGTH/DLAM/TYPE REPLACEMENT
DESCRIPTION
LGTH/DIAM/TYPE
SECTION TYPE
LEFT/RIGHT

COVER
SKEW
(APPROX)
14+50 32'-18"RCP 44'-18"RCP FILL/FILL MIN 1' 90°
17+50 32'-18"RCP 44'-18"RCP FILL/FILL MIN 1' 90°
28+50 32'-18"RCP 44'-18"RCP FILL/FILL MIN 1' 90°
34+00 28'-18"RCP 40'-18"RCP FILL/FILL MIN 1' 90°
42+00 32'-18"RCP 40'-18"RCP FILL/FILL MIN.1' 90°
60+50 NONE 40'-18"RCP FILL/FILL MIN 1' 90°

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