20050160 Ver 1_Complete File_20061206

DWQ Project No.
Applicant:
07'
County: L.?r1 co111
Project Name: S JZ I Rand it rylav-N i?-d 1T c? ?- 9-3 3 ?8(D ?CcdfY?'1tn?
Date of Issuance of 401 Water Quality Certification:
Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules,
and any subsequent modifications, the applicant is required to return this certificate to the
401/Wetlands Unit, North Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh,
NC, 27699-1621. This form may be returned to DWQ by the applicant, the applicant's authorized
agent, or the project engineer. It is not necessary to send certificates from all of these.
Applicant's Certification
I, rl - t- 14 tde / -,hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approved lans an ds ecifications, and other supporting materials.
Signature: o Date: Ia --d
Agent's Certification
I, , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approved plans and specifications, and other supporting materials.
Signature:
If this project was designed by a Certified Professional
Date:
I, , as a duly registered Professional
(i.e., Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been
authorized to observe (periodically, weekly, full time) the construction of the project, for the
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the
observation of the construction such that the construction was observed to built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans
and specifications, and other supporting materials.
Certificate of Completion
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SR 1357, Randleman Road
Bridge #33 Replacement
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Mr. Mike Holder, P.E.
NCDOT Division 12
P.O. Box 47
Shelby, NC 28151
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
pc?m oeEQ
FEB 8 - 2005
DENR - WATER QUALITY
WETLANDS AND STORMWATER BRANCH
APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Mr. Holder:
Alan W. Klimek, P.E. Director
Division of Water Quality
February 3, 2005
DWQ# 05-0160
Lincoln County
You have our approval, in accordance with the attached conditions and those listed below, to permanently
impact 80 linear feet (If) (48 for box culvert installation and 40 If for bankfull bench creation and riprap
stabilization) and to temporarily impact 40 If (for temporary cofferdam installation) of Dellinger Branch (a
perennial stream). The impacts are proposed in order to replace the existing, deteriorating bridge with a 48-
foot long double barrel, concrete box culvert (one culvert for base flow and one culvert for flood flow) as
described in your application received by the Division of Water Quality (DWQ) on February 1, 2005. The
location of the project is State Road 1357 (Randleman Road) in Lincoln County. After reviewing your
application, we have determined that this project is covered by Water Quality General Certification Numbers
3404. This certification corresponds to Nationwide Permits 14 and 33 issued by the U.S. Army Corps of
Engineers (USACE). Please note that you should get any other federal, state or local permits before
proceeding with your project, including those required by (but not limited to) Sediment and Erosion Control,
Non-Discharge, and Water Supply Watershed regulations. This approval will expire with the associated 404
permit unless otherwise specified in the Water Quality Certification.
This approval is valid solely for the purpose and design that you described in your application (unless modified
below). Should your project change, you must notify the DWQ in writing and you may be required to submit a
new application. If the property is sold, the new owner must be given a copy of this Certification and approval
letter and is thereby responsible for complying with all conditions. If total wetland fills for this project (now or in
the future) exceed one acre, or if total impacts to streams (now or in the future) exceed 150 linear feet,
compensatory mitigation may be required as described in 15A NCAC 2H.0506 (h)(6) and (7). For this approval
to remain valid, you must adhere to the conditions listed in the attached certification and those listed below:
Placement of culverts and other structures in waters, streams and wetlands must be below the elevation of
the streambed by one (1) foot for all culverts with a diameter greater than 48 inches, and 20 percent of the
culvert diameter for culverts having a diameter less than 48 inches, to allow for low flow passage of water and
aquatic life, as well as prevent headcutting of the streams. The design and placement of culverts and other
structures including temporary erosion control measures shall be installed in such a manner that the original
stream profiles are not altered (i.e., the depth of the channel must not be reduced by a widening of the
streambed). Existing stream dimensions (including pattern and profile) are to be maintained above and
below locations of each culvert. The applicant may be required to provide evidence that the equilibrium has
been maintained, if requested in writing by the DWQ.
North Carolina Division of Water Quality 610 East Center Avenue, Suite 301
Internet: h2o.enr.state.nc us Mooresville, NC 28115
Phone [phone]
Fax [phone]
lne Carolin
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Naturally
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper

Page 2
2. Since two (2) culverts will be installed, the stream should only flow through one (1) culvert during normal low
flow conditions and through the other culvert above bankfull conditions. The floodplain benches should be
installed to restore the natural channel upon completion of the project. The benches should be constructed of
natural materials for bench stability.
3. Disposal of old bridge material into surface waters is not allowed. Strict adherence to the USACE guidelines
for bridge demolition will be required.
4. Riprap must not interfere with thalweg performance and aquatic life passage during low flow conditions.
5. Erosion and sediment control practices must utilize Best Management Practices (BMP) and be in full
compliance with all specifications governing the proper design, installation, and operation and maintenance of
such BMP in order to protect surface water standards:
a. The design, installation, operation, and maintenance of the sediment and erosion control measures
must be such that they equal, or exceed, the requirements specified in the most recent version of
the North Carolina Sediment and Erosion Control Manual.
The devices shall be maintained on all construction sites, borrow pit sites, and waste pile (spoil)
projects, including contractor-owned or leased borrow pits associated with the project.
b. For borrow pit sites, the erosion and sediment control measures must be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina Surface
Mining Manual.
c. The reclamation measures and implementation of these measures must be in accordance with the
requirements of the Sedimentation Pollution Control Act.
6. Heavy equipment must be operated from the banks rather than in the stream channel, when possible, in
order to minimize sedimentation and reduce the likelihood of introducing other pollutants into the stream.
7. Temporary dewatering sites must be restored to pre-existing conditions unless more natural geomorphic
conditions can be provided.
8. No live or fresh concrete shall come into contact with waters of the state until the concrete has hardened.
9. The dimension, pattern and profile of the stream above and below the crossing should not be modified.
Disturbed floodplains and streams should be restored to natural geomorphic conditions.
10. All mechanized equipment operated near surface waters must be regularly inspected and maintained to
prevent contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic materials.
11. All work shall be performed during low or normal flow conditions.
12. Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to
surface waters is prohibited.
13. Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum extent
practicable. If placement of sediment and erosion control devices in wetlands and waters is unavoidable,
they shall be removed and the natural grade restored within 30 days after the Division of Land Resources has
released the project.
Page 3
14. The North Carolina Department of Transportation (NCDOT) and its contractors and/or agents shall not
excavate, fill or perform mechanized land clearing at any time in the construction or maintenance of this
project within waters and/or wetlands, except as authorized by this Certification, or any modification to this
Certification (e.g., no work shall occur outside of the footprint of the plans provided).
In addition, there shall be no excavation from or waste disposal into jurisdictional wetlands or waters
associated with this Certification without appropriate modification. If this occurs, compensatory mitigation
may be required since it is a direct impact from road construction activities.
15. Upon completion of the project, the applicant shall complete and return the enclosed "Certificate of
Completion form to notify DWQ when all work included in the 401 Certification has been completed. Please
include photographs upstream and downstream of the structure to document correct installation.
16. Continuing Compliance. NCDOT shall conduct its activities in a manner consistent with state water quality
standards [including any requirements for compliance with section 303(d) of the Clean Water Act] and any
other appropriate requirements of state and federal law. If DWQ determines that such standards or laws are
not being met (including the failure to sustain a designated or achieved use) or that state or federal law is
being violated, or that further conditions are necessary to assure compliance, DWQ may reevaluate and
modify this certification to include conditions appropriate to assure compliance with such standards and
requirements in accordance with 15 A NCAC 2H.0507(d). Before codifying the certification, DWQ shall notify
NCDOT and the USACE, provide public notice in accordance with 15A NCAC 21-1.0503, and provide
opportunity for public hearing in accordance with 15A NCAC 2H.0504. Any new or revised conditions shall
be provided to NCDOT in writing, shall be provided to the USACE for reference in any permit issued pursuant
to Section 404 of the Clean Water Act, and shall also become conditions of the 404 Permit for the project.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must
act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition that
conforms to Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, 6714
Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its conditions are final and binding unless
you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If
you have any questions, please telephone Polly Lespinasse in the Mooresville Regional Office at 704-663-
1699.
Sincerely,
D
for Alan W. Klimek, P.E.
Attachments
cc: Steve Lund, USACE Asheville Field Office
Rob Ridings, DWQ Wetlands Unit
Central Files
File Copy
fiift?Q
FEB 8 !,?§
,, • • 2005
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STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL, F. EASLEY DIVISION OF HIGHWAYS LYNDO TLPPETT
GOVERNOR SECRETARY
January 25, 2005
R[R&ROW7 12 Do
Mr. Steve Lund - NCDOT Projects JAN ? ? 2005
US Army Corp of Engineers
Asheville Regulatory Field Office DENR - WATER QUALITY
151 Patton Avenue, Room 208 WETLANDS AND STORMWATER BRANCH
Asheville, N. C. 28801-5006
SUBJECT: Bridge #33 replacement, SR 1357 (Randleman Rd), Lincoln County
Dear Mr. Lund:
050160
The North Carolina Department of Transportation requests authorization to replace a deteriorating bridge on
SR 1357 in Lincoln County. NCDOT proposes to replace the existing 60-foot long, 20-foot wide bridge
with a 48-foot long, double line 12' x 9' concrete box culvert with inlet and outlet headwalls on same
location. Twenty feet of Class H riprap will be utilized at the inlet and outlet of the box culvert for structure
stabilization. Riprap faced benches will be constructed at the inlet and outlet of the box culvert to maintain
channel dimensions and to divert base flow through only one barrel. The existing bridge will be removed in
accordance with NCDOT BMP's for bridge demolition. The scope of work will result in permanent impacts
to the Dellinger Branch, which is classified as a Class C waters by the Division of Water Quality. Temporary
cofferdams will be necessary to manage stream water during the staged construction of the double box
culvert. Upon project completion, areas impacted by the temporary cofferdams will be restored to pre-
project conditions.
This office has conducted a GIS and field survey for this project and is recommending a finding of "no
effect" for T&E species and historical structures.
The project is not located within %2 mile of a critical watershed area; therefore, hazardous spill basins are not
required. Enclosed is the hazardous spill basin checklist.
Enclosed is a pre-construction notification for GP 31, a sketch of planned activities, and location maps
relative to the project. If you have any questions or concerns, please feel free to contact me at (704) 480-
9044. Thank you for your time and consideration to this matter.

Y `r a_ V L e '?r
?t
Bridge 433, SR 1357,
Page 2
January 25, 2005
Respectfully yours,
M.L. Holder, P.E.
Division Engineer
Twelfth Division
BY / '?"- ?--
Trish Simon
Division 12 Environmental Supervisor
Enclosures
CC: John Hennessy, DWQ, 401/Transporation Permitting Unit (7 Copies)
Polly Lespinasse, DWQ, Mooresville Regional Office
Ron Linville, Wildlife Resources Commission (Courtesy Copy)
It
Office Use Only:
May 2002
USACE Action ID No.
(If any particular 1
is not applicable to
L Processing
050160
No.
project, please enter "Not
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ?Riparian
Rules
? Section 10 Permit ?Isolated
DWQ
® 401 Water Quality Certification
Form Version
or "N/A".)
or Watershed Buffer
Wetland Permit from
2. Nationwide, Regional or General Permit Number(s) Requested: GP31
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 the project is within a North Carolina Division of Coastal Management
Area of Environmental Concern (see the top of page 2 for further details), check here:
IL Applicant Information
1. Owner/Applicant Information
Name: Mike Holder N.C. Department of Transportation
Mailing Address: P.O. Box 47
Sheft North Carolina 28151
Telephone Number: 704-480-9020 Fax Number: 704480-5401
E-mail Address:
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: Trish Simon
Company Affiliation: N.C. Department of Transportation
Mailing Address: P.O. Box 47
Shelbx North Carolina 28151 _
Telephone Number: 704-480-9044 Fax Number: 704480-5401
E-mail Address: tsimon@a dot. state.nc.us
Page 1 of 8
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: Bridge #33 Replacement, SR 1357
2. T.I.P. Project Number or State Project Number (NCDOT Only): 33525
3. Property Identification Number (Tax PIN): NA
4. Location
County: Lincoln Nearest Town: Lincolnton
Subdivision name (include phase/lot number): NA
Directions to site (include road numbers, landmarks, etc.): From Lincolnton, east on
Hwv 27 to Hwy 73; right on SR 1509, right on SR 1357 to bridge.
5. Site coordinates, if available (UTM or Lat/Long): 35°27'16"N/81°07'53"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. Property size (acres): 0.20 CDOT right of wavl.
7. Nearest body of water (stream/river/sound/ocean/lake): Dellinger Branch, Class C
Waters (from source to Leepers Creek).
8. River Basin: Catawba
(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/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the
project at the time of this application:Existing Conditions -bridge on paved secondary
road. General Land Use- wooded, residential.
Page 2 of 8
10. Describe the overall project in detail, including the type of equipment to be used:
Replace 60' long x 20' wide timber and steel bridge with double barreL 48-foot long
12' x 9' concrete box culvert with inlet and outlet concrete headwalls. Rip" will be
installed at inlet and outlet for structure stabilization. Floodplain benches will be
constructed at inlet and outlet to maintain channel dimensions and to direct baseflow
through one barrel. The equipment utilized will include a trackhoes and crane.
11. Explain the purpose of the proposed work: The purpose of the project is to replace
the deteriorating bridge with a new structure.
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. Application for
bridge substructure repair submitted 6/20/03. Authorization obtained on 7/11/03,
USACE Authorization # 200330942 & 200330943.
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. No future permit requests are anticipated.
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 3 of 8
1. Provide a written description of the proposed impacts: 48 feet of fill from
installation of concrete box culvert. 40 feet of riprap on streambanks for structure
stabilization 80 feet of temporary cofferdam impacts for stream management during
pipe installation.
2_ Tndividually list wetland impacts below: NO WETLAND IMPACTS
Wetland Impact
Site Number
(indicate on map)
Type of Impact* Area of
Impact
(acres) Located within
100 year Floodplain**
es/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized
clearing, grading; fill, excavation, flooding, ditching/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 -MM, or FEMA-approved local floodplain maps. Maps are available through the
FEMA Map Service Center at 1-800-358-9616, or online at http://www.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: 0
Total area of wetland impact proposed: 0
-I- Tndividuallv list all intermittent and perennial stream impacts below:
Stream Imps Length
of Impact Average Width Perennial or
Site Number Type of Impact*
(linear Stream Name** of Stream Before Intermittent?
(indicate on map) Impact (please specify)
1 Box culvert 48 feet Dellinger Branch 10 feet Perennial
Riprap for 20 feet inlet
"
1 structure
stabilization 20 feet outlet
Riprap - on face -10-15 feet
of inlet and bench upstream u «
1 outlet floodplain and downstream
benches of culvert
I Temporary 40 feet (each K
cofferdams side of stream)
* 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/pin), 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 downstream named stream into which it flows. USGS maps are available through the
USGS at 1-800-358-9616, or online at www.usgs.gov. Several internet sites also allow direct download and
printing of USGS maps (e.g., www.lopozone.com, www.mayauest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: Permanent fill
impacts = 48 feet, Permanent Riprap Impacts = 40 feet Temporary impacts = 80
feet .
Page 4 of 8
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds,
Atlantic Ocean and anv other water of the U. S.) below: 0
Open Water Impact
Site Number
indicate on ma -
Type of Impact* Area of
Impact
(acres) Name of Waterbody
(if applicable) Type of Waterbody
Oake, pond, estuary' sound,
bay, ocean, etc.

• List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill,
excavation, dredging, flooding, drainage, bulkheads, etc.
5. Pond Creation: NO POND IMPACTS
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.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout
pond, local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
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 deteriorating bridge must be replaced for the safety of the travelling public Inlet and
outlet headwalls are being; utilized to minimize the length of culvert and still provide a
standard roadway and shoulder width. Riprap is necessary too provide structure
stabilization Floodplain benches are being constructed to maintain "normal" channel
width at inlet and outlet and to direct flow through main flow cell of culvert.
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
Page 5 of 8
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/strmgide.htmi.
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.
If required by USACE a request for mitigation for the project will be submitted to the
Ecosystem Enhancement Program as outlined in the memorandum of understandinu
between NCDOT and USACE.
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/wrp/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):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 6 of 8
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
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 DWQ)
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 V
Yes ? No ® If you answered "yes", provide the following
information:
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
(square feet)
Multiplier Required
on
1 3
2 1.5
Total
* 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 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. NA
Page 7 of 8
XL 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.
Minor additional impervious surface proposed from the addition of sloped shoulders
associated with replacing the 20 foot wide bridge with a box culvert.
XH. 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.
No wastewater is generated from the project.
XBL Violations (required by DWQ)
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?
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).

Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 8 of 8
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CROSSROADS

`7I
MATCH
?,c ' %
ONE C':::
ZONE A
1
/. h
ENE C
ZONE C

NOTES TO USER

?p
I
II
DEW" /

ZONE A,
KEY TO MAP
SPECIAL FLOOD HAZARD ZONE A '':':;*."'
AREA
EXPLANATION OF ZONE DESIGNATIONS
ZONE EXPLANATION
A Areas of 100-year flood; base flood elevations and
flood hazard factors not determined.
C Areas of minimal flooding. (No shading)
D Areas of undetermined, but possible, flood hazards.
V Areas of 100-year coastal flood with velocity (wave
action); base flood elevations and flood hazard factors
not determined.
Certain areas not in the special flood hazard areas (zones A and V)
may be protected by flood control structures.
This map is for flood insurance purposes only; it does not neces-
sarily show all areas subject to flooding in the community or
all planimetric features outside special flood hazard areas.
For adjoining map panels, see separately printed Index To Map
Panels.
i ? C
IRON !/ 1358
r?
INITIAL IDENTIFICATION:
DECEMBER 27, 1974
FLOOD HAZARD
BOUNDARY MAP REVISIONS:,

I 1 ,?

?lo?n:?^er 7)
V -
11
3
m

NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division: !Z County: 41"c-O"D Project ID:
River Basin: GX-7 t3,4 Bridge No:
Route: 5,9 1357 Stream: Dauve,6e- 6/L&ic- #
Water Quality Criteria: CL, s c,.l? <,
Yes No
Stream Crossing Blue Line On USGS
ORW
WSI
WS II,III OR IV, Crossing Within 0.5mi of W.S. Critical Area
Roadway Criteria:
Route Designation-
Yes No
Arterial Urban r tv'
Arterial Rural r 11"'
Additional Site Information:
r? r
r r?
r r?
r r?
Yes No
Is a Hazardous Spill Basin Required?
r r;,"
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997).
?'Q?wea•
STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
050160
MEMO TO: John Hennessy, DENR/DWQ/401/Transportation Permitting Unit
FROM: Trish Simon, Division 12 Environmental Supervisor•1)
DATE: January 25, 2005
SUBJECT: Pre-Construction Notification/401 Automated Payment
Enclosed are seven copies of a pre-construction notification for a NCDOT bridge project in
Lincoln County for your review.
Project information for the 401 Automated Payment Procedure
• Work order number: 150463-55120005-335254687-33055
• TIP #: NA
• Project Category: $200.00 Fee
is
D
JAN 2 8 X005
DENR
WATfir; UA- jr,'
?+rosro ,;y7&8 H
Post Office Box 47 Shelby, North Carolina 28151-0047
PAYWNT
RECE1 VED