20060282 Ver 1_Application_20060222

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STATE OF NORTH CAROLINA
MICHAEL F. EASLEY
GOVERNOR
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DEPARTMENT OF TRANSPORTATION rr",?rFke,,
?aPJCy
1584 YANCEYVILLE STREET, GREENSBORO, NC 27415 LYNDO TIPPETT
SECRETARY
Mrs:-John Thomas
U.S. Army Corps of Engineers
Regulatory Field Office
6508 Falls of the Neuse Road, Suite 105
Raleigh, North Carolina 2761
(Two Copies)
Ms. Sue Homewood
NC DENR Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
February 15, 2006
"°
2
SUBJECT: Guilford County, Replacement.of Bridge #23 on Davis Mill Road (SR 3433) across
Polecat Creek. Project # 37270
To Whom It May Concern:
The North Carolina Department of Transportation (NCDOT) proposes to replace an existing three
span timber deck bridge identified as Bridge 423 on Davis Mill Road in Guilford County with a three
span (1 @ 251, 1@ 50', 1 @ 25') cored slab bridge. Supports for the three spans will be outside of
the stream banks. However, this activity will likely necessitate the placement of temporary fill (100
s J) in the surface waters during construction of the southside bent. The purpose of the fill will be to
provide a lined riprap wall to protect the stream from displaced fill that will likely result from the
construction of the bent and it's proximity to the stream, The NCDOT anticipates that the proposed
filling activities will be authorized under Nationwide Permit 3. Except for the removal of the old
bridge, all other work is proposed to be along the stream banks or on high ground. Best
Management Practices will be utilized during all phases of colstruction. The temporary dewatering
activities are anticipated to be authorized under a Nationwide 33. This application is intended as a
request for formal written authorization from the USACE to replace an old bridge and to place new
fill along the stream banks under NWP 3 and NWP-33. Because the proposed activity is in the
Randleman Lake Watershed, this application is also intended to request authorization from North
Carolina Division of Water Quality. We realize that by being located within the Randleman Lake -??
Water Supply Watershed, the proposed activity is subject to protection and maintenance of riparian 'b
areas. However, we believe that through the utilization of 15A NCAC 02B.0250 (2) (e) of the NC
PHONE[phone] FAX[phone]

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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY 158,4 YANCEMLLE STREET, GREENmoRo, NC 27415
GOVERNOR
LYNDO TIPPETT
SECRETARY
Divisi,on.of Water. Q.uality.ri les.that.this gnaject.qualifies.to.receive an exempt status. By utilizing
this exemption, the NCDOT is agreeing to locate, design, construct and maintain the project to have
minimal disturbance, to prov1,& mxximum, nutrient.removal._and erosion protection, to have the least
adverse effects on aquatic life and habitat, and to protect water quality to the maximum extent
practical through the use of best management practices.
The following information-is being provided to satisfy Nationwide Permit Condition 13 (Federal
Register January 15, 2002).
PHONE [phone] FAX [phone]
PROJECT INFORMATION
' Separate documentation attached as needed: See the attached Endangered Species Review Sheet for further
information.
STRUCTURE REPLACEMENT INFORMATION
Existing 3 span timber deck bridge Proposed Three span (1 @ 25', 1@
Structure Structure 50', 1 @ 25') cored slab
bridge
Construction BMP removal of old bridge and Dewatering Riprap with filter cloth
- ... Method. placement of riprap and-high Device* during placement of
ground support bents southside bents
Burial Depth Not Applicable - Bottomless Survey Plan October 2004
Structure. Date
Construction As soon as possible Duration 2 months
Date
Impacts (ft.) No permanent stream impacts are anticipated, except during the removal of
the old pilings and bridge. All other permanent impacts are anticipated to be
upland impacts.
Temporary Temporary impacts are anticipated to be associated with the placement of
Impacts riprap (100 sf) in the stream during construction of southside bent.
Restoration Not Applicable
Plan
Special Not Applicable
Conditions
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 with the Division Environmental Officer.
Road Name SR Number* Structure Number
Davis Mill Road 3433 Bridge #23
River Basin: DIDQ Stream Name
Cape Fear WS III; 17-11- 1) Polecat Creek
Buffer ul& Buffer Rule Conditions
(where applicable) Water Quality
Designation
-Randleman Exempt- WS HI
Protected Species Presen?' CAMA
AEC Essential Fishery Habitat
No No No
-2-
MITIGATION INFORMATION
Stream mitigation is not anticipated, as the stream bottom will not be impacted as a result of this
project. Permanent impacts are limited to the placement of rip-rap dissipaters above the ordinary
high water mark.
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 Dennis Johnson at [phone] or Jerry Parker at [phone]. Your time and effort
are appreciated.
Sincerely,
M . J.M. Mills, P.E.
ibn Engineer; Diviribri 7
cc: Mr.Jerry Parker, NCDOT Division Environmental Officer
Mr. Dennis Johnson, NCDOT Bridge Maintenance Engineer
Mr.Barry Harrington, NCDOT Area Roadside Field Operations Engineer
Sue Homewood, NCDNVQ
-3-
Office Use Only: Form Version May 2002
USACE Action ID No. DWQ No. 2 0 6 0 2 8 2
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
Section 1.0 Permit [] Isolated Wetland Permit from DWQ
LJ 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 3 & NWP 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 (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4),...and tha.pr_oje.ct._is.within..a_North. Carolina. Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: Mr. J.M. Mills, RE, Division Engineer - Division 7
Mailing Address: P.O. Box 14996
Greensboro NC
Telephone Number; (33 334-3192 Fax Number: [phone]
E-mail Address: [e-mail]
2. Agent/Consultant 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: Jerry A. Parker
Company Affiliation: NCDOT
Mailing Address: P.O: Box 14996 -
Greensboro NC
Telephone Number: [phone] Fax Number: [phone]
E-mail Address:_ [e-mail]
Pagel of 9
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
USAGE- 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 Guilford Coun Bride #23 on Davis Mill Rd (SR 3433
2. T.I.P. Project Number or State Project Number (NCDOT Only):- Project # 37270
3. Property Identification Number (Tax PIN): Not Applicable
4. Location
County: Guilford Nearest Town: Climax
Subdivision name (include phase/lot number): Not Applicable
Directions to'site (include road numbers, landmarks, etc.):
The project is located southwest of Greensboro near the Guilford/Randleman coun , line on
Road (SR 3433) Turn left and go approximately 0.4 miles to the site.
5. Site coordinates, if available (UTM or Lat/Long): See Attached Mah
(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. Property size (acres): Not Applicable
7. Nearest body of water (streanihiver/sound/ocean/lake): Polecat Creek
S. River Basin:- _ Cape Fear
(Note - this -must-be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr. state. nc.us/admin/maps/.)
Page 2 of 9
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Rural forest
10. Describe the overall project in detail, including the type of equipment to be used:
The project will involve the replacement a structurally deficient timber bridge with a cored
slab bridge. Equipment used will be standard road construction equipment trackhoe, grader,
backboe, and bulldozer).
11. Explain the purpose of the proposed wor
specifications.
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.
Not A plicable
v. Future Project Plans "
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
Not Applicable
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 n separate sheet.
Page 3 of 9
Provide a written description of the proposed impacts:. No Permanent impacts are anticipated
except during the removal of the old bridge during which Best Management Practices will be
utilized. Temporary stream impacts will result from the placement of approximately 100sf of
riprap in surface,waters to be used line the stream and prevent sediment deposition Within 15
working das of the activi , all temporary structures will be entirely removed and natural stream
contours will be restored and seeded.
1. Individually list wetland impacts below:
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
feet
Type of Wetland***
N/A

a.wA cawu nnpact scparatcry aria iaentuy temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding ditching/drainage, etc. For dams, separately list impacts duo 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 httn://-%vww.fema gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated). of all existing wetlands on the property: Not Applicable
Total area of wetland impact proposed: Not Applicable
2. Individually list all intermittent and perennial stream impacts below:
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?
leasespecify)
Southside of
brid o Temporary Fill 100 sf Polecat Creek 8 to 12 it Perennial

L.a. L Uwl uupucL scparuecy aria taemtry 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 losslgain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, eta), excavation, ditching/straightcning eta 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
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usQs.zov. Several internet sites also allow direct download and printing of USGS maps (e.g, www.tbpozone.com,
WWW.mapquest.com, eta).
Cumulative impacts (linear distance in feet) to all streams on site: No permanent impacts to
-., lbe-streamare anticipated... No permanent riprap is proposed to be in the stream All bents
are to be placed upland and outside of the stream bed Temporary impacts will include the
placement of riprap in the stream during the construction of the southside bent
Page 4 of 9
3. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
indicate on ma Type of Impact* Area of
Impact Waterbody
Name of
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean etc.
N/A Temporary 100 sf Polecat Creek Perennial Stream

List each- impact separately and identify temporary impacts.- Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, eta
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.): Not Applicable
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): Not Applicable
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 maybe 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 proposed activity is being conducted to replace a structurally deficient structure and insure
the public safety Temporary impacts will be minimized by strict enforcement of Best
Management Practices for the protection of wetland and surface waters restrictions against the
staging of equipment in or adjacent to waters of the US, and coordination with the Division
Environmental Officer.
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.
Page 5 of 9
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/ncwetlands/strtngide.btin].
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.
A finding of insignificant impact is anticipated: therefore, a mitigation plan is not provided. .
No Outstandin Resource Waters, federally protected species or their habitats, or essential
fishery habitats occur in the project area. The area is within the Randleman Lake Watershed.
De project is not located in a High Quality Water. ,
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's'responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wM/index.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): Not Applicable
Amount of buffer mitigation requested (square feet):. Not Applicable
Amount of Riparian wetland mitigation requested (acres): Not Applicable
Amount of Non-riparian wetland mitigation requested (acres): Not Applicable
Amount- of Coastal wetland mitigation requested (acres): Not Applicable
Page 6 of 9
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) 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 Ej- .
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 (required by D`YQ)
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 Offee 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 213 .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 213 .0250 (Randleman Rules and
Water Supply )uffer Requirements), or other (please identify Randleman Lake Watershed )?
Yes X- No If you answered "yes", provide the following information:
The proposed activity is subject to protection and maintcuance of riparian areas. However,
we believe that through the utilization of 15A NCAC 028.0250 (2) (e) of the NC Division of
Water Quality rules that this project qualifies to receive an exempt status. By utilizing this
exemption, the NCDOT is agreeing to locate, design, construct and maintain the project to
have minimal disturbance, to provide maximum nutrient removal and erosion protection,
to have the least adverse effects on aquatic life and habitat, and to protect water quality to
the maximum extent practical through the use of best management practices
Identify. the, square. f et-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
must,p leis.
Page 7 of 9
Zone* s umarpe feet Multiplier
fired
Mitigation
1 N/A 3
2 N/A 1.5
Total N/A
# Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If Huffer-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.
Not Applicable
XI. Stormwater (required by DWQ)
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.
The proposed activity involves the replacement of an existing structure Because the percent new
impervious surface is less than-30°,'o stormwater controls are not being provided. Deck drains on
the new bride are proposed to be outside of the top of bank stream contour.
XIL Sewage Disposal (required by DWQ)
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.
Not Applicable
X1U. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 211.0500) or any Buffer Rules?
Yes ? No X
Is this an after-the-fact permit application?
Yes ? No X
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
Page 8 of 9

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).
,nt'! signature is valid-only-if an authorization letter from the applicant is provided.)
Page 9 of 9
Construction Sequence
Guilford County
Bridge 23
1. Install erosion control according to plans. Update and maintain during construction
process.
2. Layout for new bridge by setting work points and batter boards.
3. Remove existing structure using BEST MANAGEMENT PRACTICES FOR
CO,NISTR UCTIONAND MAINTE ANCE ACTIVITIES.
4. Remove demolition debris from project.
5. Construct drilled piers at bent 1 and bent 2. Extreme care is to be used not to allow
any soil or material to come into contact with stream during drilling for the piers. It
may be necessary to place Rip Rap on stream bank during construction.
6. Place concrete for caps at bent 1 and bent 2.
7. Grade area to proper grade and slope then excavate for end bent 1 and end bent 2.
8. Place class II rip rap around end bents.
9. Seed and mulch project
10. Drive H piles at end bent 1 and end bent 2.
11. Place concrete for end bent 1 and end bent 2.
12. Set cored slabs.
13. Construct approach slabs.
14. Place barrier rail.
15. Install 15" CSP with two-grate inlet.
16. Place asphalt.
17. Install guardrail.
18. Seed and mulch shoulder areas.
19. Place proper road markings.
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