20011039 Ver 1_Complete File_20010709

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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
October 2, 2001
Caswwell County
Project # 01-1039
WAIVER of 401 Water Quality Certification
Lenwood Smith
Division Seven Environmental Officer
NC Department of Transportation
1584 Yanceyville St.
Greensboro, NC 27415
Dear Mr. Smith:
Your application for a 401 Water Quality Certification was received in the Central Office on July 9, 2001. According to our rules
[15A NCAC 2H .0507 (A)], if final action is not taken within 60 days, the Certification is waived unless DWQ has objected in writing to
your application. Therefore, DWQ has waived the requirement for a 401 Water Quality Certification for your plans to replace Bridge #
48 on SR 1527 as described in your application.
However if additional impact occurs or your development plans change, this waiver is no longer valid and a 401 Water Quality
Certification will be required.
If you have any questions, please telephone John Dorney at 919-733-9646.
Cc: Winston-Salem DWQ Regional Office
Raleigh Field Office Corps of Engineers
Central Files
File Copy
4 Si ere
e 9 TUnit 1650 Mail Service Center Raleigh, NC 27699-1650 Ph: [phone] Fax: [phone]

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MEW
Customer Service
1 800 623-7748
y
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL, F. EASLEY 1584 YANCEYVILLE STREET, GREENSBORO, NC 27415
GOVERNOR
June 19, 2001
NC DENR Division of Water Quality
1650 Mail Service Center
Raleigh, NC 27699
ATTN: Mr. John Hennessy
Wetlands/401 Unit
Dear Mr. Hennessy:
LYNDo TIPPETT
SECRETARY
147 ;i6
SUBJECT: Caswell County, Replacement of Bridge # 48 on Mountain Hill Road (SR 1527)
across Coy Creek
Please find seven (7) copies a Pre-Construction Notification Application package attached for you
review. If you have any questions or need any additional information, please contact Len Smith or
Dennis Johnson at [phone]. Thank you for your time and assistance.
Sincerely,

Lenwood E. Smith, 11, PWS
Division Seven Environmental Officer
cc: Mr. Eric Alsmeyer, USACE
Ms. Renee Gledhill-Earley, SHPO
Mr. Dennis Johnson, NCDOT
PAYMENT
RECEIVED
PHONE [phone] FAX [phone]
r ?t u?
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY 1584 YANCEYVILLE STREET, GREENSBORO, NC 27415 LYNDO TIPPETT
GOVERNOR SECRETARY
June 19, 2001
U.S. Army Corps of Engineers
Regulatory Field Office
6508 Falls of the Neuse Road, Suite 105
Raleigh, North Carolina 27615
ATTN: Mr. Eric Alsmeyer.
NCDOT Coordinator
Dear Mr. Alsmeyer:
SUBJECT: Caswell County, Replacement of Bridge # 48 on Mountain Hill Road (SR 1527)
across Coy Creek
The North Carolina Department of Transportation (NCDOT) proposes to replace the existing
1 @35"6 timber deck bridge identified as Bridge # 48 with two (2) lines of 70-feet long 120"
Corrugated Metal Pipe with headwall. The existing bridge must be replaced due to structural
deficiencies. No Wetlands, High Quality Waters, or Outstanding Resource Waters occur in the
project area. T ength channel impacts from fill below the ordinary high water mark is 70-linear
feet. The tota` ength of the rip-rap energy dissipaters used to stabilize the bank is 70-feet. Total
channel impacts. are 140-linear feet.
The NCDOT anticipates that the bridge replacement activity will be authorized under Nationwide
Permit 14 and the dewatering operation will be authorized under NWP 33. This application is
intended as a request for formal written authorization from the USACE to dewater the stream under
NWP 33. This application is also intended as request for written authorization from the NC Division
of Water Quality to replace the bridge under General Water Quality Certificate # 3289 (NWP 14).
Enclosed please find the project site map and the pre-construction notification form for the above
referenced project. Construction is anticipated to begin as soon as practicable following
authorization and take three weeks to complete.
If you have any questions or need any additional information, please contact Len Smith or Dennis
Johnson at [phone]. Thank you for your time and assistance.
PHONE [phone] FAX [phone]
?Tye.+AWEn?
N r
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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY 1584 YANCEYVILLE STREET, GREENSBORO, NC 27415
GOVERNOR
Sincerely,
Lenwood E. Smith, II, PWS
Division Seven Environmental Officer
cc: Mr. John Hennessy, NCDWQ
Ms. Renee Gledhill-Earley, SHPO
Mr. Dennis Johnson, NCDOT
LYNDo TIPPETT
SECRETARY
PHONE [phone] FAX [phone]
} ?. RAIj
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY 1584 YANCEYV[LLE STREET, GREENSBORO, NC 27415
GOVERNOR
June 19, 2001
State Historic Preservation Officer
Division of Archives History
4617 Mail Service Center
Raleigh, NC 27699
CS-52-31-31
ATTN: Ms. Renee Gledhill-Earley
Dear Mrs. Gledhill-Earley:
LYNDo TIPPETT
SECRETARY
SUBJECT: Caswell County, Replacement of Bridge # 48 on Mountain Hill Road (SR 1527)
across Coy Creek
Please find a Pre-Construction Notification Application package attached for you review. If you
have any questions or need any additional information, please contact Len Smith at [phone].
Thank you for your time and assistance.
Sincerely,
Lenwood E. Smith, II, PWS
Division Seven Environmental Officer
cc: Mr. Eric Alsmeyer, USACE
Mr. Jolla Hennessy, NCDWQ
Mr. Dennis Johnson, NCDOT
PHONE [phone] FAX [phone]
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Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
http://www.saw.usace.,iriiiy.niiI/wetlands/Perm apn.litm.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at http://wvA,?v.Sa.,V.iusace.armv.mi]/wetlands/regtour.htm, or contact one of the field
offices listed at the end of this application. The website also lists the responsible project manager for
each county in North Carolina and provides additional information regarding the identification and
regulation of wetlands and waters of the U. S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h2o.enr.state.nc.us/ncwetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for some General Certifications is not required,
provided that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet
should contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is also required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on the last page of this application).
Page 1 of l 1
CAMA Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DCM) at [phone]. DCM will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (LAMA) Permit and will coordinate
the 404/401 Permits.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). Upon receipt of an application, the USACE will determine if the application is complete as
soon as possible, not to exceed 30 days. This PCN form is designed for the convenience of the applicant
to address information needs for all USACE Nationwide, Regional or General permits, as well as
information required for State authorizations, certifications, and coordination. Fully providing the
information requested on this form will result in a complete application for any of the USACE
Nationwide, Regional or General permits. To review the minimum amount of information that must be
provided for a complete PCN for each USACE Nationwide permit, see Condition 13, 65 Fed.Reg. 12893
(March 9, 2000), available at ham://,vvvw.saw.tisice.arniy.mii/wetlands/nwpfinalFedRe?pdf.
Processing times vary by permit and begin once the application has been determined to be complete.
Please contact the appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at http://h2o.ehnr.state.nc.tis/ncwetlands/fee-,.litml. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 11
Office Use Only: Form Version April 2001
0
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: 14 and 33
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
II. Applicant Information
Owner/Applicant Information
Name: Mr. J.M. Mills, PE. Division En_Rineer - Division 7
Mailing Address: 1584 Yanceyyille Street
Greensboro NC 27415
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: mrnillsndot. state. ne.us
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Mr. Lenwood E. Smith, II, PWS
Company Affiliation: NCDOT - Division 7
Mailing Address: 1584 Yanceyville Street
Greensboro, NC 27415
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: [e-mail]
Page 3 of I I
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Replacement of Bridge #48 - Caswell County
2. T.I.P. Project Number (NCDOT Only): 5.4852 (Non-TIP)
3. Property Identification Number (Tax PIN):
4. Location
County: Rockingham Nearest Town: Milton
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): Bridge # 48 on Mountain Hill
Road SR 1527) across Coy Creek. Bridge # 48 is located approximately 0.30 miles east of
the junction with Dix Road (SR 1526).
5. Site coordinates, if available (UTM or Lat/Long): 36° 32' 11.04" N 79° 18' 28.07" W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
Agricultural/Residential
7. Property size (acres): <0.01
Nearest body of water (stream/river/sound/ocean/lake): Coy Creek (Shown as Cox on the
Plan Sheet).
9. River Basin: Roanoke River
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http:Hli2o.enr.state.ne.us/admin/maps/.)
Page 4 of 11
10. Describe the purpose of the proposed work: Replace the existing 1 @35'6 timber deck
bridge identified as Bridge # 48 with two (2) lines of 70-feet long 120" Corrugated Metal
Pipe (CMP) with headwall.
11. List the type of equipment to be used to construct the project: Crane and Road construction
equipment.
12. Describe the land use in the vicinity of this project: Forest, lawn, and pasture.
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: N/A
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 5 of 11
1. Wetland Impacts
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
(es/no) Distance to
Nearest Stream
linear feet
Type of Wetland***
N/A

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditchine/drainage, etc. For dams, separately list impacts due to both structure and flooding.
* * 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at h ttn://????w. fema. eov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: N/A
Total area of wetland impact proposed: <0.01 acres
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(indicate on ma
Type of Impact* Length of
Impact
linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please seci

Bridge 48 Placement of
pipe in the
channel
20 70 (mp
Coy Creek
15'
Perennial

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
doNvnstrcam named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
ww%v. us 2 s. 2 ov. Several intemet sites also allow direct download and printing of USGS maps (e.g., \V\V\VJOpo7One.com,
-%v w. mapgnest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 70-permanent (pm), 20-
temporary (tmp)
Page 6 of 1 I
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site Number
indicate on ma)
Type of Impact* Area of
Impact
(acres) Name Waterbody
)
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.
N/A

List each impact separately and identity temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
Size of watershed draining to pond: N/A Expected pond surface area: N/A
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
The structurally deficient bridge must be replaced to ensure safetv. Impacts will be minimized
U), tJ1,11 ylnL? t11G J2IIJGS 1-1VUL UU10w JLLGi1IUMU G1GVdL1U11 LL) 1111:11 UIV: iISJUilM 111G 111UVC111C11L, UIJU
strictly enforcing Best- Management-Practices-for•the-protectiorrofwetlands Ind-surface waters.
Two lines of CMP are being used at this location due to cost constraints. The estimated cost of
the CMP lines is annroximately 540.000 dollars. -A C-on-snan-cur-Aluminum-Box-Culvert would
act as a arade control structure preventin d?equ Librium of the ers am-channel__-__--1`
Page 7 of I I
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr. state.nc.us/ncivetIands/strni,,idc.litml.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
No mitigation is anticipated because the impacts are less than 150 linear feet. In addition No
Wetlands, High Quality Waters, or Outstanding Resource Waters occur in the project area.
Coy Creek is designated as a Class C Water.
Page 8 of 11
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at hitp://h2o.enr.s???e.nc.us/??,pl;nc?cx.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ® If you answered "yes", provide the following information:
Page 9 of 11
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(s uare feet Multiplier Required
Mitigation
1 N/A 3
2 N/A 1.5
Total N/A
Lone 1 extends out 30 feet perpendicular from near bank of channel; Lone Z extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
In accordance with the February 25, 1991 delegation agreement on copy of the Sediment and
Erosion Control Plan will be sent to DENR-Division of Land Quality and NCDOT Roadside
Environmental prior to construction.
XII. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the-fact permit application?
Page 10 of 11
Yes ? No ?
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

1/O)
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 11 of 11
i ? l J?11 1r,? ? '?:f?t Sri! ., `? _ /i? ? ;??
ENDANGERED SPECIES REVIEW FOR DIVISION 7
DISTRICT 3
State Project # Bridge # SR Number County
5.4852 48 1527 Caswell
Caswell County
James sDinvmussel (111curobema collina) -- Roanoke Basin
Habitat Survey Date Investigator(s) Man-hours Comments/Findings
Yes 02/07/01 and
06/08/01 Len Smith, Tim Savidge,
Logan Williams 6.0 No mussel species observed.
Rockingham County
Smooth Coneflower (Echinacea laevigala) Mav be surveved for from June to Sentember
Habitat Survey Date Investigator(s) Man-hours Comments/Findings
N/A N/A N/A N/A N/A
James sninvmussel (Pleurohema collina) - Roanoke Basin
Habitat Survey Date Investigator(s) Man-hours Comments/Findings
N/A N/A N/A N/A N/A
Potential Species (Listed in Nearby Counties)
Schweinitz's sunflower (Helianlhus schweinilzdy Rockingham County - May be surveyed for Crum late
Au¢ust to October
Habitat Survey Date Investigator(s) Man-hours Comments/Findings
N/A N/A N/A N/A N/A
Small anthered bittercress (Cardamine micranlhera) - Rockingham and Caswell Counties (Roanoke Basin)
Mav be surveved for in Anvil and Mav
Habitat Survey Date Investigator(s) Man-hours Comments/Findings
No 02/07/01 and
06/08/01 Len Smith, Tim Savidge,
Logan Williams 6.0 No Cardamine sp. observed. No
associates observed.
General Notes/Comments:
Division Environmental Officer Date
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NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
a
Division:Seven County: Caswell Project ID: 5.4852
River Basin: Roanoke Bridge No: 48
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Route: 1527 Stream: Coy Creek
Water Quality Criteria:
Yes No
Stream Crossing Blue Line On USGS F r
ORW F F
WSI r F
WS II,III OR IV, Crossing Within 0.5mi of W. S. Critical Area r h
Roadway Criteria:
Route Designation- Yes No
Arterial Urban r F,
Arterial Rural r h
Yes No
Is a Hazardous Spill Basin Required? F F
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997).
ArlditinnnI Cite Tnfnrmntinn-
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View downstream from Bridge # 48.
View under Bridge # 48 - facing upstream.
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View of the Bridge # 48 superstructure - facing east.
1!:?j Ali 159' 14:52 1910534567 tJC DOT I EH-PIIDRTH FADE 00
. C. D. O. T,
BRIDGE NIAINTENAN-CE U11,11'
EROSION CONTROL SEQUENCE
AND CONSTRUCTION SEQUENCE
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P>3tccI' No. _# 49,Z? `
DESCRtP"'h0,4 REMOVAL OF EXISTING BRIDGE VN1) 14 . REPLACE WITH NEW
I. CONSTRUCT RIP RAP SEDIMENT DANI TY'P.E A iN STREA10
2. PLACI£ RIP RAP & INSTALL `ILT FENCE AS NEEDED
3. RtMOVE EXISTING STRUCTURE & CONSTRI'C'T TL-.`,1POR kRN
>DMIMON DAM AROUND AREA FOR PIPE # 1. (PLaet
4. BEGIN fXCAVATING AREA FOR PIPE
I, . PLACE PIPE N 1 AND STABILIZE U""TREANI AND D0NVNS1'RI',A'-l
BASIS WITH REP RAP
6. RCIM7TT WATER THROUGH PIPE t# I AND CH_1N C F Dl? E RSjoN f):k`.1
FQR PIPE 0 2
9. UGIN'tXCAVATING AREA FOR PIPE
8. PLACE ME * 2 AND STABILIZE UPSTREAM AND DOWNSTRE.-%N1
IIA?Q4 WYTH RIP RAP
s. B,AC'KML PIPES AND SEED AND MULCH THE AREA`S NFCF','l l0
AND REMOVE ALL EROSION CONTROL UPON CONIPLLTION
PREPARn RV
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DIVISI0111 OF HIGHWAYS
- CASWELL COUNTY
BRG.# 48 ON SR 1527
OVER COX CREEK
SCAIM P= SO'HORIZ
1"= 10' VBRT.
SURVEY BY. BNS LDCJU.L
DRAWN BY.- LDC
DESIGN BY. BNS
CHECKED BY:n ""/
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RECOMMENDED_ STRUCTURE
2 @ 120" CMP WITH HEADWALL
ONE STORY HOUSE
FINISH FLOOR
ELEV. 104.11 l? I I WOODS
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