20110621 Ver 1_Application_20110701

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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY PURDUE P. O. Box 25201, Raleigh, NC 27611-5202
GOVERNOR PHOxE:919-733-2520
June 20, 2011
Mr. Monte Matthews
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office
3331 Heritage Trade Drive, Suite 105
Wake Forest, NC 27587 _
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EUGENE CONTI, JR.
SECRETARY
1 1 0 6 2~~:.
~- Subject: Nationwide Permit #3
H Replace Bridge #29 on SR 1322
~ Surry County, North Cazolina
~ Project Number: 33623.1.1 (No DWQ Permit Fee Required)
Deaz Mr. Matthews:
The North Cazolina Department of Transportation is scheduled to replace Bridge #29 with a new
longer bridge at the same location. The existing 20'x 36' bridge is structurally deScient. The new
two span bridge will measure 30'x 110'. In addition to ~ 22 linear feet of additional bank
armoring, we expect 0.02 acres of cut/fill impacts to a small atypical wetland in the southwestern
quadrant. Someone has conducted ditching and side casting operations within this wetland, which
has made the soil profile irregulaz as you might expect. Impacts to this wetland aze associated
with shoulder construction and the reestablishment of the roadway ditch line. Project impacts are
tabulated below.
Project Impacts:
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Bri a #29 20'x 36' Bri a 30'x 110' Bridge 0 22 22
Total Project Impacts = 22 feet
+0.02 acres wetland cutlfdl
Construction of this project will require impacts to waters of the United States in the Yadkin
River Basin. The existing bridge crosses DTII Creek (Class: C, Trout, ORW). This project was
reviewed for the presence of threatened and endangered species in June of 2011. The subject
project will have no effect on any federally listed endangered plant or animal species. Historic
P. O.Box250,N. Wa,I~saoRO,NC 28659
PHONE [phone] FAx [phone]

Mr. Monte Matthews
Bridge #29 on SR 1322
Page 2
June 20, 2011
compliance work will be scheduled and concurrence with the State Historic Preservation Office
will be obtained if required.
The project impacts aze not significant in nature and should not alter the best usage for this
stream. All appropriate BMPs will be used during construction. Attached is a Preconstruction
Notification Form, plan sheets, photographs, a marked county map and a marked topography
map.
By copy of this letter, it is requested that Mr. Ron Linville, Mountain Region Coordinator, with
the North Cazolina Wildlife Resources Commission comment directly to you concerning the 404
Nationwide Permit application with a copy sent to me.
We would like to begin construction as soon as possible. If further information is required, please
let me know. Your early review and consideration will be appreciated.
Sincer~e~l~y~
;~~~"" _ _
Heath Slaughter
Division Environmental Officer
Enclosures
cc: Monte Matthews, US Army Corps of Engineers (1 additional copy)
Ron Linville, Western Piedmont Region Coordinator, NCWRC
Brian Wrenn, Division of Water Quality (2 copies)
Mike Pettyjohn, PE, Division Engineer
Ivan Dishman, PE, Division Bridge Program Manager
Heath Slaughter, Division Environmental Officer
Neil Trivette, Roadside Environmental Field Operations Engineer

OrpF W ATF9OG
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Office Use Only
Corps action ID no.
DWO project no.
Fonn Version 1.3 Dec 10 2008
Pre-Construction Notificafion CN Form
A. A Iicant Information
1. Processing
1 a. Type(s) of approval sough from the
Corps:
®Section 404 Permit ^ Section 10 Permit
1 b. Spedfy Nationwide Permit (NWP) number: 3 or General Permit (GP) number.
1 c. Has the NWP or GP number been verified by fhe Corps? ^ Yes ®No
1 d. Type(s) of approval sough from the DWQ (check all that apply):
^ 401 Water Qual"ilY Certification -Regular ^ Non-404 Jurisdictional General Permit
^ 401 Water Quality Certification -Express ^ Riparian Buffer Authorization
1 e. Is this notification solety for the record
because written approval is not required? For the record onty for DWQ 401
Certification:
® Yes ^ No For the record only for Corps Permit:

^ Yes ®No
1 f. Is payment into a mfigation bank or in-lieu fee program proposed for mfigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ^ Yes ®No
1 g. 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 Emironmenfal Concern (AEC)? ^ Yes ®No
2. Project Information
2a. Name of project: Bridge #29
2b. County: Surry
2c. Nearest municipal'Ay /town: Mtn. Park
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no: 33623.1.1
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT
3b. Deed Book and Page No. ""
3c. Responsible Party (for LLC ff
applicable):
3d. Street address: 801 Statesville Road
3e. City, state, zip: North Wilkesboro, NC 2A659
3f. Telephone no.: 336-903-9202
3g. Fax no.: 336-667.4549
3h. Email address: hslaughter(QD,ncdot.gov
Page 1 of 10
PCN Fortn -Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is: ^ Agent ^ Other, specify:
4b. Name:
4c. Business name
Crf applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. AgeM/consulfant Information (if applicable)
Sa. Name:
Sb. Business name
('d applicable):
:ti. Street address:
Sd. Cily, state, zip:
5e. Telephone no.:
Sf. Fax no.:
Sg. 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
1a. Properly identification no. (tax PIN or parcel ID):
1 b. Site coordinates (in deamal degrees): Latitude: 36.38732 Longitude: - 80.84107
(DD.DDDDDD) (-DD.DDDDDD)
1 a Property size: 0.4 acres
2. Surface Waters
Za. Name of nearest body of water (stream, river, etc.) to
proposed project: Mill Creek
2b. Water Quality Classfication of nearest receiving water: C, Trout, ORW
2c. River basin: Yadkin
3. Project Description
3a. Describe the existing condrbons on the site and the general land use in the vicinity of the project at the time of this
application:
Substandard bridge to be replaced in a rural area
3b. List the total estimated acreage of a0 existing wetlands on the property:
- 0.2 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perenniaQ on the property:
- 200 linear feet
3d. Explain the purpose of the proposed project:
Upgrade substandard stream crossing
3e. Describe the overall project in detail, including the type of equipment to be used:
See attached cover letter.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this properly /
project (including all prior phases) in the past?
Comments:
^ Y~ ®No ^ Unknown
4b. If the Corps made the jurisdictional determination, what type
of determination was made? ^ preliminary ^ Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Agency/Consultarrt Company:
Other
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
6a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past? ^ Yes ®No ^ Unknown
Sb. If yes, explain in 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
1a. 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 impaled.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impal Type ofjurisdiction
number - Type of impel Type of wetland Forested (Corps - 404, 10 Area of impel
Permanent (P) or (if known) DWO -non-404, other) (acres)
Tem ore
^ Ye_s ®Corps 0
02
Wt ®P ^ T CuUFill Seep ® No ®DWQ .
^ Yes ^ Corps
W2 ^ P ^ T ^ No .. ^DWQ
^ Yes ^ Corps
W3 ^ P ^ T ^ No ^DWQ
^ Yes ^ Corps
W4 ^ P ^ T ^ No ^DWQ
^ Yes ^ Corps
W5 ^ P ^ T ^ No ^DWQ
^ Yes ^ Corps
W6 ^ P ^ T ^ No ^DWQ
2g. Total wetland imparts
Zh. Comments: Wetland has been ditched wdtr side casting. Soil profile is a mess.
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 impaled.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impel Type of impel Stream name Perennial Type ofjurisdiction Average Impel
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or iMermitteM pyyO _ non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 ®P ^ T Riprap Mill Creek ®PER
^INT ®Corps
®DWQ - 10 22
^ PER ^ Corps
S2 ^ P ^ T ^ INT ^ DWO
^ PFJ2 ^ Corps
S3 ^ P ^ T ^ INT ^ DWO
^ PER ^ Corps
S4 ^ P ^ T ^ INT ^DWQ
^ PER ^ Corps
S5 ^ P ^ T ^ INT ^DWQ
^ PER ^ Corps
S6 ^ P ^ T ^ INT ^DWQ
3h Total stream and tributary impacts ~
3i. Comments: No impacts to waters from the new bridge itself, just riprap.
Page 4 of 10
PCN Fonn -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 - (ff applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Tem ora
01 ^P^T
02 ^P^T
03 ^P^T
04 ^P^T
4t Total open water impacts
4g. Comments:
5. Pond or Lake Construction _
If nd or lake construction ro osed, then com lets the chart below:
5a. 5b. Sc. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
PondlD Proposed use or purpose (acres)
number of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
Sf. Total
Sg. Commerds: N/A
5h. Is a dam high hazard permit required?
^ Yes ®No If yes, permit ID no:
5i. Effected pond surtace area (aces):
5j. Size of pond watershed (aces):
Sk. Method of construction:
6. Buffer Impacts (for DWQ)
If project vnll impact a protected riparian buffer, then complete the chart below. If yes, then individually list a0 buffer impacts
below. If an im acts re uire miff ation, then ou MUST fill out Section D of this fonn_
6a.
^ Neuse ^Tar-Pamlico ^ Other:
Project is in which protected basin? ^ Catawba ^ Randleman
6b. tic. 6d. tie. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mfigafion (square feet) (square feet)
Tem ora im ad re utred?
^Yes
61 ^P^T ^ No _
^Yes
B2 ^P^T ^ No
^Yes
B3 ^P^T ^ No
6h Total buffer impacts
6i. Comments:
Page 5 of 10
PCN Form -Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Replacing bridge with new bridge.
1b. Spedficalty describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Atl appropriate BMPs will be used during construction
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Wafers 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. Complete if 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 fo 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 megaton, stream temperature: ^ warm ^ cool ^cold
4d. Buffer megaton requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: aces
4f. Norxiparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: aces
4h. Commerce:
5. Complete ff Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Fonn -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
buffer mNgation? ^ Yes ®No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of megaton required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier se•
Required mrbgaton
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mtgation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved irrlieu fee fund).
6h. Comments:
Page 7 of 10
PCN Fonn -Version 1.3 December 10, 2008 Version

E. Storrnwater Management and Diffuse Fbw Plan (required by DWQ)
1. Diffuse Flow Plan

1 a. Does the project include or is it adjacent to protected riparian buffers identified
within one of the NC Riparian Buffer Protection Rules? ^ Y~ ®No
1 b. If yes, then is a diffuse flow plan included? If no, explain why. ^ Y~ ^ No
Comments:
2. Stormwater Ma Plan

2a. What is the overall percent imperviousness of this project? 50
2b. Does this project require a Stormwater Management Plan? ®Yes ^ No
. 2c. ff this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a StomnNater Management Plan, then provide a brief, narrative description of the plan:
See attached Stormwater Permit request.
^ Certified Local Government
2e. Who will be responsble for the review of the Stormwater Management Plan? ^DWQ Stormwater Program
® DWQ 401 Unit
3. Certfied Local Government Stomrvvater Review

3a. In which local govemmenYs jurisdiction is this project?
^ Phase II

3b. Which of the following locally-implemerrted stormwater management programs
appy (check all that apply): ^ NSW
^ USMP
^ Water Suppty Watershed
^ Other:
3c. Has the approved Stomwvater Management Plan with proof of approval been ^ Yes ^ No
attached?
4. DWQ Stormwaler P ram Review
^ Coastal counties

4a. Which of the following state-implemerded stomiwater management programs apply
(check all that appy): ^ HOW
®ORW
^ Session Law 2006-246
^ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ^ Y~ ^ No
5. DWQ 401 Unk Stormwater Review

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
Page 8 of 10
PCN Forth -Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federaUstate/local) funds or the ®Yes ^ No
use of public (federaUstate) land?
1 b. If you answered 'yes' to the above, does the project require preparation of an
t
l
St
^ Yes
®No
e
or
a
environmental document pursuant to the requiremerds of the Nationa
(North Carolina) Environmental Policy Act (NEPAISEPA)?
1 c. It you answered yes" to the above, has the document review been fmal¢ed by the
State Clearing House? (If so, attach a copy of the NEPA w SEPA fmal approval ^ Yes ^ No
letter.)
Comments:
2. Violations (DWQ Requirerneni)
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 "yes" 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 reasonabty anticipated future impacts) resuR in ^ Y~ ®No
addrtional development, which could impact nearby downstream water qualilt/?
3b . H you answered 'yes' to the above, submit a qualitative or quantitative cumulative impact analysis in accordance wdh the
most recent DWQ policy. If you answered'no; provide a shoR narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the uHimate treatment methods and disposition (non-0ischarge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject fadlily.
N/A
Page 9 of 10
PCN Form -Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
Sa. 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 Speces Act ^ ./~ ®No
impacts?
^ Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
^ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Speces or Designated Critical
Habitat?
GIS 8 visual observation
6. Essential Fish Habihat (Corps Requiremend)
6a. Will this project occur in or near an area designated as esserrflal fish habitat? ^ Yes ®No
6b. What data sources did you use to determine whether your site would impact Esserrlial Fish Habitat?
WRC will comment
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
govemmer><s have designated as having historic or cultural preservation ^ yes ®No
status (e.g., National Historic Trust designafion 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?
8. Flood Zone Designation (Corps Requirement)
Ba. Will this project occur in a FEMA-designated 100-year floodplain? ®Yes ^ No
8b. If yes, e>~lain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? ncfloodmaps
J. Heath Slaughter ~~ 6/20/11

Applicarrt/Agent's Printed Name ApplicartUAgeM's Signa
(Agent's 'nature is valid only if an author¢alio alter from the applicant Date
is ovided.
Page 10 of 10
PCN Form -Version 1.3 December 10, 2008 Version

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1.
3.
5.
1.
3.
Bridge #29, Surry, Northern Abutment.
Upstream view.
2.
4.
2. Bridge #29, Surry, Southern Abutment.
4,5. Wetland in SW quad.

DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Determination Manual)
Project /Site: Bridge #29 on SR 1322
Applicant /Owner. NCDOT
Investigator: Heath Slauehter Date: 6/20/1 t
County: Sum
State: NC

Do normal circumstances exist on the s"rte? Yes_ tYo x Community ID:
Is the site significantly disturbed (Atypical skuation)? Yes x No_
Is the area a potential problem area? vas No x Transact ID:
-Plot ID:
(explain on reverse if needed)
VEGETATION
Darrina~rt P1aM Species Stratum Indicator DpminaM Plant Sceeies Stratum Indicator
.
1. Juncus el7usus tIeib FACW+ 9.
2. Impatiens cacensis Herb FACW 10.
3. Euoatoriade maculates I-Ierb FACW- 11.
4. Carex sup. 12.
5. 13.
6. 14.
7. 15.
8. 16.
Percent of Dominant Species that are OBL, FACW, or FAC excluding FAC-). 100
Remarks:
HYDROLOGY
_ Recorded Data (Describe In Remarks): Wetland Hydrology Indicators
_ Stream, Lake, or Tide Gauge
Aerial Photographs Primary Indicators:
_
Other x Inundated
- x Saturated in Upper 72"
x No Recorded Data Available -Water Marks
- Drift Lines
Field Observations: - Sediment Deposits
x Drainage Patterns in Wetlands
Depth of Surface Water: ~ I (~) Secondary Indicators:
x Oxidized Roots Channels in Upper 12"
Depth to Free Water in Pit: 0 fin.) Water-Stained Leaves
_
- L.ocat Soil Survey Data
Depth to Saturated Soil: 0 (in.) x FAC~leutral Test
- Other (Explain in Remarks)
Remarks:
Wetland has tlcen ditched with excavated material side cast into the wetland.

SOILS
Map UnH Name
(Series and Phase): Braddock fine sandy loam Drainage Class: Well Drained
Taxonomy (Subgroup): mesic Twic I-Iapludults Confirm Mapped Type? Yes_ No x
l~rofik Description:
Depth Matrix Colors Mottle Colors Mottle Texture. Concretions,
(inches) Horizon (Mansell Moist) (Mansell Moist) AbundancelContrast - Stmcture. etc.
Hydric Soil Indicators:
Soils
_ Histosol
Histic Epipedon
_ Sulfidic Odor
_Aquic Moisture Regime
Reducing Conditions
x Gleyed or Low~hroma Colors
-Concretions
-High Organic Content in Surface Layer in Sandy
-Organic Streaking in Sandy Soils
-Listed On Local Hydric Soils List
-lasted on National Hydric Soils List
-Other (Explain in Remarks)
Did not complete soil prafde due to disturbance. Hydric soils wem found inside of the wetland.
WETLAND DETERMINATION
Hydrophytic Vegetation Present? Yes x No
Wetland Hydrology Present? Yes x No
Hydric Soils Presets? Yes x No
Is the Sampling Point
Wkhin a Wetland? Yes x No_
Remarks:

WETLAND RATING WORKSHEET
(Fourth Version)
Project Name: Bridge #29 on SR 1322 Nearest Itd. SR 1322
County: Sorry Wetland Area: 0.02(acres) Wetland Width: 30 (feet)
Name of Evaluator: Heath Slaughter Dale: 6/20/11
Wetland LocaNoo
^ Cn pond or lake
^ On perennial stream
^ On intermittem stream
^ Within intermittent stream divide
® other: Seep
Soil Series: Braddock
^ Predominantly organi-hukmus, muck, or peat
® Predominantly mineral-nonsandy
^ Predominantly sandy
Hydraulic Factors
® Steep topography
> ®Ditched or channelized
^ Total wetland width > 100 feet
Adjacent Land Use
Forested/natural vegetation 90%
Agriculture, urban/suburban
Impervious surface l0%
Dominant Vegetation
(I) Juncos eHrrstu
(2) Impatiens capensis
(3) Eupatoriade maculatus
Flooding and Wetness
^ Semipermanenfly [o permanently
flooded or immdated
^ Seasonally flooded or immdated
® Inteanittaruly flooded or temporary
Surface water
^ No evidence of flooding or surface water
Wetland Type (select one)
^ Bottomland Hardwood Forest
^ Headwater Forest
^ Swamp Forest
^ Wet Flat
^ Pacosin
^ Bog Forest
^ Pine Savanna
^ Freshwater Marsh
^ Bog/Fen
^ Ephemeral Wetland
^ Carolina say
® Cnher: Seep
fThe rating system cannot be applied to salt or brackish marshes or stream channels.
12ating
Water Storage 1 X 4.00 = 4
Bank/Shoreline Stabelization 1 X 4.00 = 4 WETLAND RATING
.Pollutant Removal 1 X 5.00 = 5 20
Wildlife Habitat 1 X 2.00 = 2 ' "
Aquatic Life Value 1 X 4.00 = 4
Recreation/Education 1 X 1.00 = 1
"Add 1 point if in sensitive watershed and > 10 % no~oird disturbanc ewithin % mile upstream,
upslope, or radius.

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BEVERLY PURDUE
GOVERNOR
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
P. O. Box 25201, Raleigh, NC 27611-5202
PHOxE:919-733-2520
June 27, 2011
Stormwater Section
N.C. Division of Water Quality
Winston-Salem Regional Office
585 Waughtown St.
Winston-Salem, NC 27107
Attention: Ms. Amy Euhss
~~~~~e~
SUN
tt~,'~ ~ 2011
""wVD D~~~q
H
EUGENE CONTI, 7R.
SECRETARY
Subject: State Stormwater Permit Request for the replacement of Bridge #29 over Mill Creek on
SR 1322 in Surry County. Debit WBS 33623.1.1 $505.
Dear Ms. Euhss:~
The North Cazolina Department of Transportation is scheduled to replace Bridge #29 with a new longer
bridge at the same location. Since this bridge crosses an outstanding resource water, I have included a
Stormwater Application Form, the Project Scope Narrative, two sets of the project plans and the authority
to debit $505 for the permit application fee. Please review this project for authorization by your Division.
We would like to begin construction as soon as possible. If further information is required, please let me or
Ivan Dishman, PE Imow. Your early review and consideration will be appreciated.
Sincere/ly,~
/~Ek?~t~
Heath Slaughter
Division Environmental Officer
Enclosures
cc: Monte Matthews, US Army Corps of Engineers
Brian Wrenn, Division of Water Quality
Mike Pettyjohn, PE, Division Engineer
Ivan Dishman, PE, Division Bridge Program Manager
Heath Slaughter, Division Environmental Officer
Neil Trivette, Roadside Environmental Field Operations Engineer
P. O. Box 250, N. WR.roiseoRO, NC 28659
PHONE [phone] FAx [phone]

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
LINEAR ROADWAY PROJECT
Thisjorm may be photocopied jar vse as an anginal.
DWO Stormwater Maoasemerrt Plan Review:
A complete stonnwater management plan submittal includes this application form, a supplement form for each BMP
proposed (see Section V), design calculations, and plans and specifications showing all road and BMP details.
I. PROJECT INFORMATION
NCDOT Project Number: 33623.1.1 Coumy: Sur '
Project Name: TIP# B-4284 Replace Bridge #29 on SR 1322 over Mill Creek -
Project Location: 1.2 miles NE of Mtn. Pazk
Contact Person: Ivan Dishman_ PE Phone: [phone] Fax: [phone]
Receiving Stream Name: Mill Creek River Basin: Yadkin Class: C. Trout. ORW
Proposed tineaz feet of project: 400
Proposed Structural BMP and Road Station (attach a list ofstation and BMP type if more room is needed):
Grass fill embanlrnient
Type of proposed project: (check all that apply):
^ New ^Widening ^2 lane* ^41ane* ^Curb and Gutter ®Bridge Replacement
^Other (Describe)
*1 lane and 41ane imply that roadside ditches are used unless Curb and Gutter is also checked.
II. REQUIRED ITEMS CHECKLIST
Initial in the space provided below to indicate the following design requirements have been met and supporting
documentation is attached. Supporting documentation shall, at a minnnum, consist of a brief narrative description
including (1) the scope of the project, (2) how the items below are met, (3) how the proposed best managemem practices
minimize water quality impacts, and (4) any significant constraints and/or justification for not meeting a, b, c and d to the
maximum extent practicable.
D er's Initials
L~a. The amount of impervious surface has been minimized as much as possible.
b. The runoff from the impervious areas has been diverted away from surface waters as much as possible.
c. Best Management Practices aze employed which minimise water quality impacts.
~ ~ d. Vegetated roadside ditches are 3:1 slope or flatter.

III. OPERATION AND MAINTENANCE AGREEMENT
I aclmowledge and agree by my initials below that the North Carolina Department of Transportation is responsible for the
implementation of the four snairstenance items listed. I agree to notify DWQ of any operational problems with the BMP's
that would impact water quality or prior to making any changes to the system or responsible party.
Maintenance Engineer's Initials
ti/ a. BMP's shall be inspected and maintained in good working order.
~J~~b. Eroded azeas shall be repaired and reseeded as needed.
a Stormwater collection systems, including piping, inlets, and outlets, shall be maintained to insure proper
functioning.
Maintenance Engineer's
IV. APPLICATION CERTIFICATION
I, (pant or type name) Zya.v~ ~~ s~~^^~'I of ~, v I I ~ ~O H Branch,
certify that the information included on this permit application form is, to the best of my knowledge, correct and that the
project will be constnrcted.in conformance with the approved plans and that the proposed project complies with the
requirements of 15A NCAC 2H .1000.
Title: ~V S~Oh L]•t-~re T'o5,•d», ~{,,,,.,o,szr
Address: i'~t Box 2C~ N W'.~~as~~ ~ N C 281a s9
V. SUPPLEMENT FORMS
The applicable state stormwater management permit supplement form(s) listed below must be submitted for each BMP
specified for this project. Contact the Stormwater and General Permits Unit at (919) '733-5083 for the status and
availability of these forms.
Form SW401-Low Density
Form SW401-Curb Outlet System
Form SW401-0ff-Site System
Form SW401-Wet Detention Basin
Form SW401-Infiltration Basin
Form SW401-Infiltration Trench
Form SW401-Bioretention Cell
Form SW401-Level Spreader
Form SW401-Wetland
Form SW401-Grassed Swale
Form SW401-Sand Filter
Low Density Supplement
Curb Outlet System Supplement
Off-Site System Supplement
Wet Detention Basin Supplement
Infiltration Basin Supplement
Underground Infiltration Trench Supplement
Bioretention Cell Supplement
Level Spreader/Filter Strip/Restored Riparian Buffer Supplement
Constructed Wetland Supplement
Grassed Swale Supplement
Sand Fffter Supplement
Title: ~/~If

I
STORMWATER MANAGEMENT PLAN
Project: 33623.1.1, TIP# B-4284 June 22, 2011
Surry County
Project Engineer: Ivan Dishman, PE
Roadway Description
This project consists of replacing Bridge #29 over Mill Creek on SR 1322 and improving the
roadway bridge approaches. The existing 20'x 36' bridge is structurally deficient and will be
replaced with a new 30'x 110' bridge at the same location. An off-site detour will be utilized
during construction. Total project length is 400 linear feet. The existing 8' travel lanes will be
widened to 13', including the paved shoulders. Due to tapering, impervious surface azea will
increase by approximately 0.05 acres. The project drainage wnsists of one drop inlet and stub
out pipe near station 10+75 left as well as a rock lined ditch running through an already ditched
and disturbed wetland in the southwestern quadrant of the bridge.
Environmental Description
This project is located in the Yadkin River Basin and is not subject to riparian buffer rules. Mill
Creek is classified as Class: C, Trout, ORW at this location. No other jurisdictional streams will
be impacted by this proposed project.
Best Manasement Practices and Maior Structures
The primary goal for Best Management Practices (BMPs) is to prevent degradation of the state's
surface waters by the location, construction and operation of the highway system. BMPs are
activities, practices and procedures taken to prevent or reduce stormwater pollution. Due to
steep terrain and limited right-of--way, there is not a suitable location for a structural BMP.
II, Reuuired Items Checklist
The proposed structure is a 110' long 2 span 21" cored slab bridge with spill through abutments.
Approximately 4001inear feet of roadway is being widened, including the bridge.
a. Minimized to the extent hydraulically possible.
b. Stortnwater on the southern end of the project will sheet flow off of the roadway.
Due to the required superelevation of the bridge, flow from the northern section of
the bridge is concentrated into a drop inlet near station 10+75 lt. This inlet will
dischazge as faz away from Mill Creek as reasonably possible. Due to steep terrain,
it is not possible to install a preformed scour hole but we can and will install a rock
energy dissipater pad. Stormwater will sheet flow from there to the creek, which is
located about 20 feet to the west. No deck drains are called for in the plans. There
will be no slots in the railing so all drainage will be routed to the ends of the bridge.

c. Topogaphic and right-of--way constraints make the installation of a structural BMP
infeasible. We did consider piping stormwater from the DI at station 10+75 (lt.) to
the small flat landing zone on the other side of the road. It was thought that we may
have room there for at least an undersized preformed scour hole at the pipe outlet.
Doing so however would increase discharge velocities due to the excessive pipe
slope needed to accomplish the task. We saw no benefit to this proposal so the idea
was abandoned. Roadway fill slopes will be vegetated. All appropriate construction
BMPs will be employed during bridge demolition and reconstruction.
d. N/A. The only roadside ditch associated with the project is running through a
disturbed wetland adjacent to the road. The slope on this ditch line ranges between
4% - 8%, which requires a rock liner per DLQ rules for stability purposes.
Flattening side slopes of this ditch line would result in an increase in wetland
impac[s.

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