20110302 Ver 1_Application_20110401

STATE OF NORTH CAROLINA
DEPARTNMNT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
March 29, 2011
Ms. Amy Euliss
NC DENR Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
Mr. Andrew Williams
US Army Corps of Engineers
6508 Falls of the Neuse Suite 120
Raleigh, NC 27615-6814
(Two Copies)
Subject: Guilford County, Carmen Road (SR 2755)
Project Number # 7B.204114.18
To Whom It May Concern:
?.?0302
EUGENE A. CONTl, JR.
SECRETARY
V@120W[20
APR 0 1 2011
DENR • WATER QUALITY
WMMDS AND STDRMWATER BRANC H
The North Carolina Department of Transportation (NCDOT) proposes to replace a deficient bridge with a
new bridge on Carmen Road (SR 2755) in Guilford County. Replacement is necessary in order to reduce
future maintenance needs and increase traffic safety. The project is over Rock Creek which is within the
Jordan Lake watershed and it will involve buffer impacts. The NCDOT anticipates that the activity will be
authorized under Nationwide Permit (NWP) 3. This application is intended as a courtesy notification to the
US Army Corps of Engineers. This package is also being forwarded to the NC Division of Water Quality for
authorization as prescribed under General Water Quality Certification #3687 (NW 3) and a written buffer
authorization. The following information is being provided to satisfy conditions of the Nationwide Permit
and General Water Quality Certification.
P.O. Box 14996 Greensboro, NC 27415-4996 Telephone No. [phone] Fax No. [phone]
PROJECT INFORMATION
e Separate documentation attached as needed: 1; See the attached Endangered Species Review Sheet for further information: ` When
Applicable - See the attached Historic Review Letter for further information
BRIDGE REPLACEMENT INFORMATION
Road Name SR Number Project Length
(miles) Classification
Carmen Road SR 2755 N/A Subdivision
River Basin: DWQ
ID Water Quality
Designation
%Impervious Surface
Cape Fear 16-19-375-(1) WS-IV; NSW N/A
Buffer Rulese Buffer Rule Conditions (where applicable)
Yes Jordan Lake
Protected Species Presentb Mapped Historic
Properties' CAMA
AEC Essential Fishery Habitat
No No No No
Site Station N/A Stream Type Perennial
Existing Stream 10 to 20 feet Proposed N/A
Width Stream Width
Construction Bridge to bridge construction from high Dewatering N/A
Method ground to high ground. No bents proposed in Device'
stream
Burial Depth N/A E/C Plan N/A
Date
Construction As soon as practicable Duration
Date
Impacts ft. No stream impacts. Total buffer impacts of 349 sf, all in Zone One.
Special Construction of grassed Swale per stormwater BMP to obtain diffuse flow.
Conditions
Restoration Plan Within 15 working days of the project completion any disturbed area adjacent to the stream will be
restored and seeded.
RCP = reinforced concrete pipe; CMP = Corrugated metal pipe; CMPA = Corrugated metal pipe arch; E/C = Erosion control. 'A less intrusive
dewatering device may be used in lieu of the one proposed.
MINIMIZATION INFORMATION
Impacts will be minimized by strict enforcement of Best Management Practices for the protection of
surface waters and wetlands, restrictions against the staging of equipment in or adjacent to waters of
the US, and coordination )including a pre-construction meeting) with the Division Environmental
Officer.
MITIGATION INFORMATION
Stream mitigation is not anticipated, as the impacts to any individual stream do not exceed 150 feet
Wetland mitigation is not anticipated, as wetland impacts do not exceed 0.10 acres and do not occur
in a unique natural wetland. Buffer impacts equaling 349 of in Zone One are anticipated.
APPLICATION INFORMATION
Enclosed please find the Pre-construction Notification Form and supporting documentation for the
above referenced project. If you have any questions or need any additional information, please
contact Jerry Parker at [phone]. Your time and effort are appreciated.

Sincerely,
0 _, I WE-
Mr. J.M. Mills, P.E.
Division Engineer, Division 7
Enclosures
CC: Tim Powers, Bridge Maintenance NCDOT
Barry Harrington, NCDOT
Paul Ingram, NCDOT
NC Wetlands/40I Unit
W AT fq
T
? r
O
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PCN Form
A. Applicant Information
1. Processing
1 a . Type(s) of approval sought from the
Corps: ? Section 404 Permit
? Section 10 Permit
1 b . Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number: NWP 3
1c. Has the NWP or GP number been verified by the Corps? ? Yes ® No
Id . Type(s) of approval sought from the DWQ (check all that apply):
? 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ® Riparian Buffer Authorization
le. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
? Yes ® No For the record only for Corps Permit:

® Yes ? No
If. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. El Yes ®
No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ? Yes ® No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: Carman Road (SR 2755)
2b. County: Guilford .
2c. Nearest municipality /town: McCleansville
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
project no: 78.204114.18
3. Owner Information
3a. Name(s) on Recorded Deed:
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page I of 10
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: N Agent ? Other, specify:
4b. Name: J. M. Mills
4c. Business name
(if applicable):
Division Engineer NCDOT Division Seven
4d. Street address: P.O. Box 14996
4e. City, state, zip: Greensboro, NC 27415
4f. Telephone no.: 336 3343297
4g. Fax no.:
4h. Email address:
6. Agent/Consultant Information (if applicable)
5a. Name: Jerry Parker
5b. Business name
(if applicable):
Division Environmental Supervisor
5c. Street address: P.O. Box 14996
5d. City, state, zip: Greensboro, NC 27415
5e. Telephone no.: 336 256-2063
5f. Fax no.:
5g. Email address:
Page 2 of 10
PCN Form - Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax PIN or parcel ID): N/A

1b. Site coordinates (in decimal degrees): Latitude: 36.1112093 N Longitude: -
79.6027171 W
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: N/A acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project:
Rock Creek
2b. Water Quality Classification of nearest receiving water: WS-IV; NSW
2c. River basin: Cape Fear
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Rural wooded area adjacent to rural residences and farmland
3b. List the total estimated acreage of all existing wetlands on the property:
0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
60
3d. Explain the purpose of the proposed project:
Replace deficient bridge with a new bridge
3e. Describe the overall project in detail, including the type of equipment to be used:
Replace bridge in same alignment. Bridge replacement will be high ground to high ground with no bents in the stream. No
wetlands are located on the site.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property !
project (including all prior phases) in the past?
Comments:

® Yes ? No ? Unknown
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
®Preliminary ? Final
C. If yes, who delineated the jurisdictional areas?
Name (d knownAndy Williams Agency/Consultant Company:
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5.
ry
Sa. or certifications been requested or obtained for
cluding all prior phases) in the past?
t
? Yes ® No ? Unknown
in
5b. detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 3 of 10
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
? Wetlands ? Streams - tributaries ® Buffers
? Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number -
Permanent (P) or Type of impact Type of wetland
if k Forested (Corps - 404, 10 Area of impact

Tem
orar (
nown) DWQ - non-404, other) (acres)
p
y
W1 ? P ? T ? Yes ? Corps
? No ? DWQ
W2 ? PEI T ? Yes ? Corps
? No ? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? PEI T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ?DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number -
Permanent (P) or (PER) or (Corps - 404, 10 stream length

Temporary (f) intermittent
(IN
T) DWQ - non-404, width (linear

fe
t
• other) (feet) e
)
? T ? PER ® Corps
? INT ? DWQ
? T ? PER ? Corps
? INT ? DWQ
? T ? PER ? Corps
? INT ? DWQ
? T
1 ? PER ? Corps
? INT ? DWQ
? T ? PER ? Corps
? INT ?DWQ
? T ? PER ? Corps
? INT ?D
NQ
31LTotal
stream and tributary impacts
3i. Comments:
Page 4 of 10
PCN Form - Version 1.3 December 10, 2008 Version
4. Open water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Temporary
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d.

Pond ID
Proposed use or purpose
Wetland Impacts (acres)
Stream Impacts
(feet) Upland
number f
o
pond
Flooded Filled Excavated Flooded Filled 4
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes ? No I f yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individuall y list all buffer impacts
below. If an im acts re uire mitigation, then you MUST fill out Section D of this form.
6a.
Neuse
El ? Tar-Pamlico ® Other: Jordan
Project is in which protected basin? El Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number -
Permanent (P) or Reason
for
Stream name Buffer
mitigation Zone 1 impact
(square feet) Zone 2 impact
(square feet)
Tern ore impact required?
B1 ®P ? T Bridge Rock Creek El Yes 95 sf 0
No
®
62 ®P ? T CrRoad ossing Rock Creek ® Yes El No 168 sf 0
B3 ® PEI T Parallel
Stream Rock Creek ? Yes
® No
86 sf
p
6h Total buffer impacts 349 sf 0
6i. Comments:
Page 5 of 10
PCN Fort - Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
I a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Impacts will be minimized by utilization of Best Management Practices
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Best Management Practices will be utilized during construction. Utilization of grassed swale to reduce TSS, Nitrogen and
Phosphorus impacts . Existing ditchline will not be increased in size nor altered. Pre-construction meeting with Environmental
Superevisor will take place prior to commencing construction
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State? ? Yes ® No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation option will be used for this
project? ? Mitigation bank

? Payment to in-lieu fee program
? Permittee Responsible Mitigation
3. Completed Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
[Sa. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Forth - Version 1.3 December 10, 2008 Version
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires ® Yes ? No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 Construction of deficient
bridge 349 sf 3 (2 for Catawba)
) 1047 sf
Zone 2 N/A 0 1.5 0
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
NCDOT requests to do buffer mitigation through EEP.
6h. Comments:
Page 7 of 10
PCN Form - Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified ER Yes ? No
within one of the NC Riparian Buffer Protection Rules?
1b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments: Diffuse flow will be obtained by utilization of a grassed swale whose size
has been calculated to meet the requirements of the best management practices for Z Yes ? No
stormwater. Based on design calculations, estimated removal of TSS is 88% and
estimated removal of Nitrogen and Phosphorus is 67% each.
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? N/A %
2b. Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Stormwater flow will be to existing
drainage ditches, roadside ditches and stormwater conveyances. Existing ditchlines will not be increased in size or
altered. Flows resulting from less than one inch per hour of precipitation should not after or result in the need to alter the
conveyance and will be managed to minimize the sediment, nutrients and other pollution that convey to water bodies.
Stormwater flow from the bridge will be directed by pipe to the installed grassed swale.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
® DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local governments jurisdiction is this project? - ---
? Phase II
3b. Which of the following locally-implemented stormwater management programs ? NSW
apply (check all that apply): ? USMP
? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review
? Coastal counties

4a. Which of the following state-implemented stormwater management programs apply ? HQW
? ORW
(check all that apply): ? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ? Yes ? No
5. DWQ 401 Unit Stormwater Review
Page 8 of 10
PCN Form - Version 1.3 December 10, 2008 Version
5a . Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No
5b . Have all of the 401 Unit submittal requirements been met? ? Yes ? No
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
I a . Does the project involve an expenditure of public (federal/state/local) funds or the ®Yes ? No
use of public (federal/state) land?
1b . If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ? Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
I c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ? Yes ? No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ? Yes ®No
2c. If you answered 'es" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
dditi
l ? Yes ® No
a
ona
development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. 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.
N/A
Page 9 of 10
PCN Form - Version 1.3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or ? yes No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
El Yes No
®
impacts?
Sc. If yes, indicate the USFWS Field Office you have contacted.
® Raleigh
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
US Fish and Wildlife Web Site
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
N/A
7. Historic or Prehistoric Cultural Resources (Corps Requiremeut)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation ? Yes ®No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
National Historic Register Web Site
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ? Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? NC Floodplain Mapping Information System
J.M. Mills ? 1 ` , I P 3(3?' ! I
Applicant/Agent's Printed Name U Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant
s ovide J.
Page 10 of 10
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Carmon Road- Downstream view from road
Carmon Road- View of bridge from downstream side

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Name: GIBSONVILLE Location: 036.1117531° N 079.6013314° W
Date: 3/29/2011 Caption: Carmen Road (SR 2755)
Scale: 1 inch equals 2000 feet Guilford County