20120636 Ver 1_Application_20120627

cis � 1
STATE OF NORTH CAROLINA
DEPARTMENT OF TRAN3PORTATION
BEVERLY EAVES PERDUE
GovERNOR
June 25 2012
N C Division of Water Quality
Winston -Salem Regional Office
585 Waughtown St
Winston- Salem, NC 27107
Attention Ms Amy Euless
D�
N2
44,10 K?4
FR
EUGENE CONTI, 9 *y
SECRETARY
1�QVJ\D
Subject State Stormwater Permit Request for the replacement of Bridge # 37 over UT to Stony
Creek on SR 1611 (Sartin Rd) in Alamance County Debit VMS 45353 114 $505
Dear Ms Euless
The North Carolina Department of Transportation is scheduled to replace Bridge 437 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 Jordan Lake 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 this 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 (336) 256 -2063 Your early review and consideration will be appreciated
Sincerely
J Mills P E
vision Engineer Division 7
Enclosures
cc Amy Euhss NCDWQ
Jerry A Parker Division Environmental Supervisor
James Lastnnger US Army Corps of Engineers
Tun Powers NCDOT
NCDENR DWQ Wetlands /401 Unit Raleigh, NC
Barry Harrington, Roadside Environmental Field Operations Engineer
P O Box 14996 GREENSBORO NC 274154996
PHONE [phone] FAx [phone]

A �
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H Sullins
Governor Director
Attachment L Low Impact Bridge Replacement Process
Low Impact Bridge Project No BD -5107S County - Alamance
Bndge No 37 over UT to Stoney Creek WBS Element Number 45353 1 20
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 June 21, 2012
Applicant Name NCDOT
Applicant Address 1584 Yancevville Street
Greensboro NC 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-II, HQW, 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
Dee Freeman
Secretary
Project Description — The project consists of replacing Bridge #37 over an UT to Stony Creek
on SR 1611 (Sartin Rd) and improving roadway approaches The existing 52 L X 20 W bridge is
structurally deficient and will be replaced with a new 90 L X 30 W bridge at the same location
An off site detour will be utilized during construction Total project length is 450 ft Bridge
impacts will involve 1165 sf of impacts in Zone 1 and 6 sf in Zone 2 Road impacts within the
buffer will involve 351 sf in Zone 1 and 656 sf of impacts in Zone 2 Total buffer impacts for
Zone 1 will be 1516 sf and for Zone 2 will be 662 sf Therefore a buffer authorization is being
requested No surface water impacts are anticipated The project will involve less than 0 02 ac of
Transportation Permitting Unit One
1650 Mail Service Center Raleigh North Carolina 27699 1650 NorthCarolina
Location 2321 Crabtree Blvd Raleigh North Carolina 27604 /�y+ /
Phone [phone] \ FAX [phone] ah( ally
Internet http / /h2o enr tate nc us /ncwetlands/

mechanized clearing in wetlands and less than 0 01 ac of wetland fill within the buffer that is
necessary in order to construct the bridge to current NCDOT standards No permanent stream
impacts are anticipated A stormwater management plan and application are also attached
Signature
Print Name M Mills P E
Title Division Engineer, Division 7

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
This font may be photoeopled for use as an orWnai
DWO Stormwater Manaiiemeimt Plan Revww.
A complete stormwater management plan submittal includes this application foam, a supplement form for each BMP
proposed (see Section V), design calculations and plans and specifications showing all road and BUT details
PROJECT INFORMATION
NCDOT Project Number 45353 1.20 County Alamance
Project Name BD- 51075. Ralacement of Bridge No. 37 on SR 1611 over UT to Stony Creek
Project Location SR 1611 (Sarhn Road) m Alamance Comm 0 4$ mules north of junction with SR 1609
Contact Person Mr. Jerry Parker Phone [phone] Fax L) ,334 -4149
Receiving Stream Name UT to Stones_ River Basin Q= Fear Class WS IL HOW. NSW
Proposed linear feet of project 450 LF
Proposed Structural Me and Road Station (attach a list of station and BMP type If more room is needed)
None
Type of proposed project (check all that apply)
❑ New OWidening 132 lane* 04 lane* ❑Curb and Gutter ® Bndge Replacement
❑Other (Describe)
*2 lane and 4 lane imply that roadside ditches are used unless Curb and Gutter is also checked
IL REQUIRED UEMS CHECKLIST
hutial in the space provided below to indicate the fbUowmg design requirements have been met and supporting
documentation is attached Supporting documentation shall, at a minimum, 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 management practices
mmmm= water quality impacts and (4) any significant constraints and/or justification for not meeting a, b c and d to the
maximum extent practicable
Designer s Initials
O SP a. The amount of impervious surface has been nmmrmmed as much as possible
DSr—_b The runoff from the impervious areas has been diverted away from sum faoe waters as much as possible.
DS F c Best Management Practices are employed which minimize water quality impacts.
qA d. Vegetated roadside ditches are 3 1 slope or flatter
(No proposed ditches, provide sheet flow on grass shoulders along roadway at all four quadrants)
Form SWU -112 Rev 04 00 Page 1 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 BUT's
that would impact water quality or prior to making any changes to the system or responsible party
Maintenance Engineer s Inttrals
J_a BMP s shall be inspected and maintained in good working order
J b Eroded areas shall be repaired and reseeded as needed
J c Stormwater collection systems including piping, inlets, and outlets shall be maintained to insure proper
functioning
Maintenance Engineer's Name
W
Title c.M t. 11
IV APPLICA'T'ION CERTIFICATION
1, (print or type name) Jerry Parker of Htg�wgv Division 7 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 constructed in conformance with the approved plans and that the proposed pr4lect complies with the
requirements of 15A NCAC 2H 1000
Address
Signature-
V SUPPLEMENT FORMS
Date- (— d0 - /,Z
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 [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
Nem River Basin Supplement
Innovative Best Management Practice Supplement
Extended Dry Detention Basin Supplement
Form SWU 112 Rev 04 00 Page 2 of 2

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Date 6/19/2012 Caption Sartin Rd (SRI 611)
Scale 1 Inch equals 2000 feet Alamance County

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