20201518 Ver 1_BR-0048 MCDC_20201030

MINIMUM CRITERIA DETERMINATION CHECKLIST
The following questions provide direction in determining when the Department is
required to prepare environmental documents for state-funded construction and
maintenance activities. Answer questions for Parts A through C by checking either
"Yes" or"No". Complete Part D of the checklist when Minimum Criteria Rule
categories #8, 12(i) or#15 are used.
TIP Project No.: BR-0048
State Project No.: 67048.1.1
Project Location: Surry County,North Carolina (see attached vicinity map)
Project Description: Replace Surry County Bridge No. 103 on NC 268 over the
Mitchell River. The new bridge will be placed immediately north of the existing
structure and traffic maintained on the existing bridge during construction. The typical
sections for the bridge and approaches are as follows:
-L- {NC 268)
Bridge Typical
34'-0"
'5' 12' ! 12'
E MIN I MINE
�f I
.02,
-L- (NC 2681 Approach Typical
8' 12' 12' 8' 8'
11'W/GR
5 j t .S.
FDPS 1 ■ FiPS ORIGINAL
GROUND
02 .21 . •02_ _ .42 �e
Zl
ORIGINAL
GROUND
04/16/19 1 of 6

Anticipated Permit or Consultation Requirements: Nationwide Permit and 401
Certification
Special Project Information:
Bicycle and Pedestrian Concerns
NC 268 is part of the Mountains to Sea Trail. NC 268 is also identified in the locally
adopted Elkin-Jonesville Comprehensive Transportation Plan. For these reasons,both
the approaches and the bridge will be set up to accommodate bicycles.
Surry County is planning the Mitchell River Greenway for NC 268. They have not
progressed in planning to know which side they would cut a bench into the slope under
the bridge. The west end is not practicable because it would require an extension of
the bridge and would contend with a power transmission line corridor running
overhead. The design plans have made provision for a passage under the east end of
the bridge. The county has been notified of the accommodation the Department can
make.
Public Involvement
A Land Owner Notification Letter was sent to all property holders within the study
area at the beginning of planning. The final design extended beyond the original study
area and will impact the outbuilding shown in Figure 2. A letter has been sent to alert
the property holder of the impact and offer a contact should they have any questions.
No comments have been received to date.
04/16/19 2 of 6

PART A: MINIMUM CRITERIA
Item 1 to be completed by fie Engingil YES NO
1. Is the proposed project listed as a type and class of activity allowed under IX
the Minimum Criteria Rule in which environmental documentation is not
required?
If the answer to number 1 is"no",then the project does not qualify as a
minimum criteria project. A state environmental assessment is required.
If yes,under which category? (26)Implementation of any project which
qualifies as a"categorical exclusion"under the
National Environmental Policy Act by one of
the Agencies of the U.S.Department of
Transportation
If either category#8,#12(i)or#15 is used complete Part D of this checklist.
Although Item 26 doesn't meet one of these categories, it is appropriate to
answer the questions in Part D because of the nature of the project.
PART B: MINIMUM CRITERIA EXCEPTIONS
Items 2—4 to be completed by the Engineer. YES NO
2. Could the proposed activity cause significant changes in land use ❑ IZI
concentrations that would be expected to create adverse air quality
impacts? The proposed project will only replace the function of the existing
bridge.
3. Will the proposed activity have secondary impacts or cumulative ❑ IZI
impacts that may result in a significant adverse impact_to human health
or the environment? The proposed project will only replace the function of
the existing bridge.
4. Is the proposed activity of such an unusual nature or does the proposed ❑ IZI
activity have such widespread implications,that an uncommon concern
for its environmental effects has been expressed to the Department? No
concerns have been expressed.
Item 5-8 to be completed by Division Environmental Officer.1
5. Does the proposed activity have a significant adverse effect on wetlands; IX
surface waters such as rivers, streams,and estuaries;parklands;prime or
unique agricultural lands; or areas of recognized scenic,recreational,
archaeological, or historical value? No. Source:NRTR and CIA in file and
cultural resources screenings attached.
6. Will the proposed activity endanger the existence of a species on the IX
Department of Interior's threatened and endangered species list?
Source: See NRTR and explanation in Question 9 below.
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7. Could the proposed activity cause significant changes in land use ❑
concentrations that would be expected to create adverse water quality or
ground water impacts?
The proposed project will only replace the function of the existing bridge.
YES NO
8. Is the proposed activity expected to have a significant adverse effect on X
long-term recreational benefits or shellfish, finfish,wildlife, or their
natural habitats.
The impacts of the project will be very limited both during and after
construction.
If any questions 2 through 8 are answered"yes",the proposed project may not qualify as a
Minimum Criteria project. A state environmental assessment(EA)may be required. For
assistance, contact:
Manager, Environmental Analysis Unit
1598 Mail Service Center
Raleigh,NC 27699-1598
(919) 707—6000
Fax: [phone]
PART C: COMPLIANCE WITH STATE AND FEDERAL REGULATIONS
[Items 9-12 to be completed by Division Environmental Officer. ' YES NO
9. Is a federally protected threatened or endangered species, or its X
habitat, likely to be impacted by the proposed action?
The Northern Long eared bat is currently unresolved but with the
anticipated outcome of either"No Effect"or"May Affect,Not Likely to
Adversely Affect". The issue will be resolved and addressed prior to
receiving a permit.
10. Does the action require the placement of temporary or permanent
fill in waters of the United States?
A temporary causeway will likely be necessary for construction of
the new bridge and demolition of the old structure.
11. Does the project require the placement of a significant amount of X
fill in high quality or relatively rare wetland ecosystems, such as
mountain bogs or pine savannahs?
Source: NRTR
12. Is the proposed action located in an Area of Environmental ❑ X
Concern, as defined in the Coastal Area Management Act?
Source: Not in the 20 CAMA counties
Items 13—15 to be completed by the Engineer.
13. Does the project require stream relocation or channel changes? ❑ X
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Cultural Resources
14. Will the project have an"effect" on a property or site listed on the X
National Register of Historic Places?
15. Will the proposed action require acquisition of additional right of 7
way from publicly owned parkland or recreational areas?
Questions in Part"C" are designed to assist the Engineer and the Division Environmental
Officer in determining whether a permit or consultation with a state or federal resource
agency may be required. If any questions in Part"C" are answered"yes", follow the
appropriate permitting procedures prior to beginning project construction.
04/16/19 5 of 6

PART D:(To be completed when either category#8, 12(i)or#15 of the rules are
used.)
16. Project length: 1410 feet
17. Right of Way width: Varies (see attached
figure)
18. Project completion date: 2020
19. Total acres of newly disturbed ground 1.47 acres
surface:
20. Total acres of wetland impacts: 0
21. Total linear feet of stream impacts: 34 feet
22. Project purpose: Replace deficient bridge
Prepared by: kfiktuln2s Date: i//6, 21319
R &K Project Manager
Reviewed by: Date: `f it Co (19
OT E AP Specialist
5/6/2019
Approved by: Date:
NCDOT EAU Unit Head
04/16/19 6 of 6

PROJECT COMMITMENTS:
T.I.P. No. BR-0048
Bridge No. 103 on NC 268
Over Mitchell River in Surry County,NC
WBS # 67048.1.1
Mountains to Sea Trail
The design of the project will accommodate bicycles regarding paved shoulders
and the approaches and regarding offset and bicycle safe rail on the bridge.
Mitchell River Greenway
The plans will contain a bench cut into the slope under the bridge on the east end
to provide passage for a future greenway.
State Minimum Criteria Checklist Determination Page 1 of 1
Green Sheet
Apr 2019

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. I Surry Co. Bridge No. 103
On NC 268 over Mitchell River
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Figure 2
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Project Tracking No.(Internal Use)
17-12-0009
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t ail
HISTORIC ARCHITECTURE AND LANDSCAPES
NO SURVEY REQUIRED FORM
i' This form only pertains to Historic Architecture and Landscapes for this project. It
is not valid for Archaeological Resources. You must consult separately with the
Archaeology Group.
PROJECT INFORMATION
Project No: BR-0048 County: Surry
WBS No.: 67048.1.1 Document MCC
Type:
Fed.Aid No: N/A Funding: ® State ❑ Federal
Federal ® Yes ❑No Permit
Permit(s): Type(s):
Project Description: Replace Bridge No. 850103 over Mitchell River on NC 268.
SUMMARY OF HISTORIC ARCHICTECTURE AND LANDSCAPES REVIEW
Description of review activities, results, and conclusions:
Review of HPO quad maps, HPO GIS information, historic designations roster, and indexes was
undertaken on December 18, 2017. Based on this review, there are no existing NR, SL, LD, DE,
or SS properties in the Area of Potential Effects, which is 450' from each end of the bridge and
75' from the centerline each way. A survey site, the original Bridge 103 which was a five-panel
Truss Bridge, has been replaced by this current bridge. A one-story Shiloh Primitive Baptist
Church fall within the APE to the east of the bridge. The structure is unremarkable and is not
distinctive or unique; it is not eligible for NR listing. There are no National Register listed or
eligible properties and no survey is required. If design plans change, additional review will be
required.
Why the available information provides a reliable basis for reasonably predictinj that there
are no unidentified sijinificant historic architectural or landscape resources in the project
area:
HPO quad maps and GIS information recording NR, SL, LD, DE, and SS properties for the
Surry County survey, Surry County GIS/Tax information, and Google Maps are considered valid
for the purposes of determining the likelihood of historic resources being present. There are no
National Register listed or eligible properties within the APE and no survey is required.
SUPPORT DOCUMENTATION
Map(s) nPrevious Survey Info. ❑Photos Correspondence Design Plans
FINDING BY NCDOT ARCHITECTURAL HISTORIAN
Histo is c itecture and Land apes --NO SURVEY REQUIRED
([ RI (ter
NCDOT Architectural Historian Date
Historic Architecture and Landscapes NO SURVEY REQUIRED form for Minor Transportation Projects as Qualified in the 2007 Programmatic Agreement.
Page 1 of 4

Project Tracking No.
17-12-0009 REVISED
.44, NO ARCHAEOLOGICAL SURVEY REQUIRED FORM :X 40
ig
' ' . This form only pertains to ARCHAEOLOGICAL RESOURCES for this project. It is not t�,
::..o a:, valid for Historic Architecture and Landscapes. You must consult separately with the V
a'w'" Historic Architecture and Landscapes Group.
PROJECT INFORMATION
Project No: BR-0048 County: Surry
WBS No: 67048.1.1 Document: State Minimum Criteria Checklist
Federal Aid No: Funding: ® State ❑ Federal
Federal Permit Required? 171 Yes n No Permit Type: USACE
Project Description:
Replace Bridge 103 on NC 268 over the Mitchell River in Surry County. Area of Potential
Effects (A.P.E.) is approximately 688 meters (2,257 ft.) long and 90 meters (300 ft.) wide. No
design plans were provided. The project is State-funded, and Federal permits will be required.
No easements will be required.
NOTE: A No Archaeological Survey Required form for this project was submitted on 1/17/2018.
The A.P.E. was expanded in November 2018 from 372 meters (1,219 ft.) long and 60 meters
(200 ft.) wide to 688 meters (2,257 ft.) long and 9 meters (300 ft.) wide. The recommendation
has not changed, but the new information is provided in this revised form.
SUMMARY OF CULTURAL RESOURCES REVIEW
Brief description of review activities, results of review, and conclusions:
The review included an examination of a topographic map, an aerial photograph, and listings of
previously recorded sites, previous archaeological surveys, and previous environmental reviews
at the Office of State Archaeology(O.S.A.). NC 268 is oriented approximately east-west.
The topographic map (Elkin North, N.C.) shows the A.P.E. is located in a narrow river valley
with steep slopes on each side. The landforms in the A.P.E. are the narrow strips of level land
along the river, and steep slopes up to ridge tops on each side. The level ridge tops are outside of
the A.P.E. These landforms have a low potential for archaeological sites. There may be a small
section of level ridge toe at the east end of the southeast quadrant.
The aerial photograph shows the landuse in the A.P.E. is mostly wooded. There is a house and
yard located at the east end of the southeast quadrant. The house and yard occupy the small
section of level ridge toe on the topographic map. A powerline is located in the northwest and
southest quadrants.
A review of information at the O.S.A. shows there are no previously recorded archaeological
sites within or near the A.P.E. The A.P.E. is not within any areas that have been surveyed for
archaeological sites. The A.P.E. is not within any projects that have been reviewed by the State
"No ARCHAEOLOGY SURVEY REQUIRED"form for Minor Transportation Projects as Qualified in the 2015 Programmatic Agreement.
1 of 6

Project Tracking No.
17-12-0009 REVISED
Historic Preservation Office (HPO).
Brief Explanation of why the available information provides a reliable basis for reasonably
predicting that there are no unidentified historic properties in the APE:
The landforms within the A.P.E. have a low potential for archaeological sites.
SUPPORT DOCUMENTATION
See attached: ® Map(s) ❑ Previous Survey Info Photos Correspondence
❑ Photocopy of County Survey Notes Other:
FINDING BY NCDOT ARCHAEOLOGIST
NO ARCHAEOLOGY SURVEY REQUIRED
Caleb Smith 1/4/2019
NCDOT ARCHAEOLOGIST II Date
"No ARCHAEOLOGY SURVEY REQUIRED"form for Minor Transportation Projects as Qualified in the 2015 Programmatic Agreement.
2 of 6