20120551 Ver 1_Application_20120605

STATE OF NORTH CAROLINA
DEPARTMENT OF 1 RC SPORTATION
BEVERLY PURDUE P 0 Box 25201 Raleigh, NC 27611 5202
GovERNoR PHONE [phone]
May 11 2012
N C Division of Water Quality
Winston -Salem Regional Office
585 Waughtown St
Winston- Salem, NC 27107
Attention Ms Amy Euless
o�
EUGENE �C��JR.
SECRETARY
Subject State Stormwater Permit Request for the replacement of Bridge 4135 over North Fork
Little river on SR 1516 in Orange County Debit WBS 45353 1 15 $505
Dear Ms Euhss
The North Carolina. Department of Transportation is scheduled to replace Bridge #135 with a new longer
bridge at the same location Since this bridge crosses a High Quality Water I have included a Stormwater
Application Form, the Project Scope Narrative a set of the project plans and the authority to debit $505 for
the Permit application fee
Because the project is within the Neuse River Watershed, a buffer authorization is also required I am
requesting review through the Low Impact Bridge Replacement Process I have included Attachment L with
a project description and set of the project plans Please review tins project for the appropriate
authorizations by your Division
We would like to begin construction as soon as possible If further information is required, please contact
Jerry Parker at [phone] Your early review and consideration will be appreciated
Sincerely
J Mills P E
ivision Engineer Division 7
Enclosures
cc Jerry A Parker Division Environmental Supervisor
James Lashnger US Army Corps of Engineers
Tun Powers NCDOT
NCDENR DWQ Wetlands /401 Unit Raleigh, NC
Barry Harrington, Roadside Environmental Field Operations Engineer
P O Box250 N W=EsaoRo NC 28659
PHONE [phone] FAX [phone]

LT,
"
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H Sullins Dee Freeman
Governor Director
Secretary
Attachment L Low Impact Bridge Replacement Process
Low Impact Bridge Project No BD -5107N County - Orange
Bridge No 135 over North Fork Little River WBS Element Number 45353 1 15
This project is subject to the Low Impact Bridge Process as agreed to on October 6
2009 This project meets the documentation requirements and approval procedures
under NEPA, as defined by FHWA, for Low Impact Bridge Replacements This project
meets the standards of NCDOT's Minimum Criteria Rules
Date May 8 2012
Applicant Name NCDOT
Applicant Address 1584 Yanceyville Street
Greensboro INC 27415
Primary Contact for Project Jerry A Parker
Phone No 336 256 2063
Is this an after the fact application Yes X No
River Basin Cape Fear
Stream Classification WS-V, NSW
Regulatory Authorization Options for this Activity
Federal USACE Nationwide General Permit 3 — Maintenance
State General Water Quality Certification #3883 and/or Buffer Authorization
Local None
Project Description — The project consists of replacing Bridge #135 over North Fork Little River
on SR 1516 (Brown Rd) and improving roadway approaches The existing 40 5 X 20 bridge is
structurally deficient and will be replaced with a new 80'X 30 bridge at the same location An
off -site detour will be utilized during construction Total project length is 550 ft Bridge impacts
will involve 771 sf of impacts in Zone 1 and 91 sf in Zone 2 Total buffer impacts for Zone 1 will
be 771 sf and for Zone 2 will be 91 sf Therefore a buffer authorization is being requested No
stream or wetland impacts are anticipated A stormwater management plan is also attached
Transportation Permitting Unit One
1650 Mad Service Center Raleigh North Carolina 27699 1650 NOrthCarOhna
Location 2321 Crabtree Blvd Raleigh North Carolina 27604 ���������
Phone [phone] FAX [phone]
Internet http //h2o enr state nc us /ncwetlands/

III= uiv[51on mngineer, uivision

i
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
NORTH CAROLINA DEPARTMIFNT OF TRANSPORTATION
LINEAR ROADWAY PROJECT
79rts fonn may be photocopeed for use as an anginal
DWO &=–Water Management Plan Review
A complete stormwater 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
PROJECT INFORMATION
NCDOT Project Number 45353 1 15 County Orange
Project Name• BD 5107N Replacement of Badge No 13 on SR 1516 over North Fork Little River
Project Location SR 1516 Brown Road) in Orange County, 0.7 milesAgith of junction with SR 1517
Contact Person ark Phone [phone] Fax [phone]
Receiving Stream Name North Fork Little River River Basin Now Class WS IL HOW, NSW
Proposed linear feet of project 550 LF
Proposed Structural BMP and Road Statism (attach a list of station and BMP type :# more room is needed)
None
Type of proposed project (check all that apply)
0 New DWudemng 02 lane* 04 lane* ❑Curb and Gutter ®Bridge Replacement
❑Other (Describe)
*2 lane and 4 lane imply that roadside ditches are used unless Curb and Gutter is also checked
IL REQUIRED ITEMS CHECKLIST
Imtal in the space provided below to indicate the following design requirements have been met and supporting
documentation is attached. Supporting documentation shall, at a minimum, consist of a bnef narrative description
including (1) the scope of the prgject, (2) how the items below are met, (3) how the proposed best management practices
minimize water quality impacts, and (4) any significant constraints and/or justification for not meetmg a, b c and d to the
maximum extent practicable
Designer s Initials
D-S Fa The amount of rmpervrous surface has been mm m,zed as much as possible
_S -b The runoff from the impervious areas has been diverted away from surface waters as much as possible
DSP c Best Management Practices are employed which minimize water quality impacts
MIA d. Vegetated roadside ditches are 3 1 slope or flattex
(No proposed ditches provide sheet flow on grass shoulders along roadway at all four quadrants)
Form 9WU 112 Rev 04 00
Pagel of 2
Fee Paid
Permit Number
Date Reoelved
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
NORTH CAROLINA DEPARTMIFNT OF TRANSPORTATION
LINEAR ROADWAY PROJECT
79rts fonn may be photocopeed for use as an anginal
DWO &=–Water Management Plan Review
A complete stormwater 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
PROJECT INFORMATION
NCDOT Project Number 45353 1 15 County Orange
Project Name• BD 5107N Replacement of Badge No 13 on SR 1516 over North Fork Little River
Project Location SR 1516 Brown Road) in Orange County, 0.7 milesAgith of junction with SR 1517
Contact Person ark Phone [phone] Fax [phone]
Receiving Stream Name North Fork Little River River Basin Now Class WS IL HOW, NSW
Proposed linear feet of project 550 LF
Proposed Structural BMP and Road Statism (attach a list of station and BMP type :# more room is needed)
None
Type of proposed project (check all that apply)
0 New DWudemng 02 lane* 04 lane* ❑Curb and Gutter ®Bridge Replacement
❑Other (Describe)
*2 lane and 4 lane imply that roadside ditches are used unless Curb and Gutter is also checked
IL REQUIRED ITEMS CHECKLIST
Imtal in the space provided below to indicate the following design requirements have been met and supporting
documentation is attached. Supporting documentation shall, at a minimum, consist of a bnef narrative description
including (1) the scope of the prgject, (2) how the items below are met, (3) how the proposed best management practices
minimize water quality impacts, and (4) any significant constraints and/or justification for not meetmg a, b c and d to the
maximum extent practicable
Designer s Initials
D-S Fa The amount of rmpervrous surface has been mm m,zed as much as possible
_S -b The runoff from the impervious areas has been diverted away from surface waters as much as possible
DSP c Best Management Practices are employed which minimize water quality impacts
MIA d. Vegetated roadside ditches are 3 1 slope or flattex
(No proposed ditches provide sheet flow on grass shoulders along roadway at all four quadrants)
Form 9WU 112 Rev 04 00
Pagel of 2

III. OPERATION AND MAINTENANCE AGREEMENT
I acknowledge and agree by my initials below that the North Carolina Department of Transportation is responsible for the
implementation of the four maintenance items listed I agree to notify DWQ of any operational problems with the BMW s
that would impact water quality or prior to making any changes to the system or responsible party
Maint ante Engineer s Initials
a BMP s shall be mspected and maintained In good working order
b Eroded areas shall be repaired and reseeded as needed.
�c Stormwater collection systems, Including piping, mlets and outlets, shall be maintained to msure proper
functioning
Maintenance Engineer's N
I, (print or type name) _retry Parker of HtghwayIhyision 7 __ Branch,
certify that the information included on this permit application farm is to the best of my lmowledge, correct and that the
requirements of
protect well be f 1 SA NCAC 2H i 000 constructed m conformance with the approved plans and that the proposed project complies with the
Title Division Environmental Superyisor
Addrew 1584 Yanmmna la zt to n U- 1 eoMc
Signature-
V SUPPLEMENT FORMS
Date _ S —/V —
f
The applicable state stormwater management permit supplement form(s) hated below must be submitted for each BMP
specified for this project Contact the Stormwater and General Permits Unit at [phone] for the status and
availability of these forms
Form SWU 102
Form SWU -103
Form SWU -104
Form SWU 105
Form SWU 106
Form SWU 107
Form SWU 108
Form SWU -109
Form SWU -110
Wet Detention Basin Supplement
Infiltration Basin Supplement
Low Density Supplement
Curb Outlet system Supplement
Off Site System Supplement
Underground Infiltration Trench Supplement
Neuse River Basin Supplement
Innovative Best Management Practice Supplement
Extended. Dry Detention Basin Supplement
Form SWU 112 Rev 04 00 Page 2 of

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Attachment G Low /Minimal Impact
Bridge Pro,ect Data Sheet
1
ITIP NO
B
B
B
B
2
JWBS Element No
453531 15
3
lCounty
Orange
4
Bridge Number
135
51
Description
Brown Rd Replace Bridge
over North Fork Little River
6
Basin
Neuse
7
Classification
WS II HOW NSW
8
Stream
SIN
27221 3
9
Type
Perennial
10
Size
11
IType
Bridge
12
Existing Structure
Isize
13
ISuff Rating
15
Proposed Structure
Tye
Bridge
16
Stream
USACE (LF)
0
17
NCDWQ Impacts (LF)
0
18
USACE Impacts (AC)
0
19
Wetlands
Non 404 Impacts (AC)
0
20
ICAMA Impacts SF
0
21
NC DWQ Buffers im acts SF
Yes
22
Buffer Applicaton Required (YIN)
Yes
23
State Stormwater Permit Required (Y /N)
Yes
24
Habitat
no
25
T&E
Species Present
no
26
Rio Conclusion
no effect
Moratorium
IType
no
28
1 Dates
no
29
Native/Hatchery
N/A
30
Trout Waters
Trout Species Present
N/A
31
Trout Conditions (Y /N)
N/A
32
WRC Reviewer
N/A
331
CAMAIAECs
no
01
Essential Fishl
Habitat
no
351
Nov
10pening
no
36
USCG
I Permit
no
37
Historic
Properties
no
38
Archaeological
Resources
no
39
Tribal
I Lands
no
40
4
Resources
no
41
6 (Q [LWCF]
I Resources
42
Wild and
Scenic River
no
43
Federal
Lends
no
44
TVA
(Area
N/A
45
FEMAIBu
out
N/A
46
FEMAIFlood
Study
N/A
471
USTs
Haz Mats
N/A
48
Relocatees
N/A
49
Location
LAT
360 59' 58 63 N
50
LONG
790 4 10 35 W
51
Project Comments
Completed by
Date
2-1
Lead Engineer
Date
D ision Environments Officer

it
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