20120906 Ver 1_Application_20121002

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STATE OF NORTH CAROLINA 40sTa14 �'40
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DEPARTMENT OF TRANSPORTATION FRak
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BEVERLY EAVES PERDUE EUGENE A" CONTI,JR
GOVERNOR SECRETARY
September 27 2012
Ms Amy Eulizs
NC DENR Division of Water Quality
585 Waughtown Street 6
Wmston Salem,NC 27107
Mr Andy Williams
US Army Corps of Engineers
6508 Falls of the Neuse Suite 120
Raleigh,NC 27615-6814
(Two Copies)
Subject Rockmgham County Lemons Road (SR 1104)
Project Number# 17BP 7 R.32
To Whom It May Concern
The North Carolina Department of Transportation (NCDOT) proposes to replace Bndge #50 on Lemons Road
(SR 1104) in Rockingham County The proposed work is necessary in order to reduce future maintenance
needs and increase traffic safety The bridge replacement qualifies for the Low Impact Bridge Replacement
agreement established between the NCDOT and environmental agencies However a private driveway
exists adjacent to the bridge which will require relocation due to the necessary installment of guardrail
along the road The existing driveway spans a UT to Hogans Creek via a 12 inch X 25 ft CMP The new
driveway is proposed to be approximately 37 feet upstream of the existing site and will utilize a 18 inch by
30 ft CMP The project is within the Roanoke River basin and therefore does not involve buffer impacts
The NCDOT anticipates that the relocation will be authorized under Nationwide Permit(NWP) 14 This
package is also being forwarded to the NC Division of Water Quality for authorization as prescribed under
General Water Quality Certification#3886 (NW 14) The following information is being provided to satisfy
conditions of the Nationwide Permit and General Water Quality Certification
P 0 Box 14996 Greensboro NC 27415-4996 Telephone No [phone] Fax No [phone]

PROJECT INFORMATION
Road Name SR Number Project Length Classification
(miles)
Lemons Road SR 1104 N/A Subdivision
Riper Basin
DWQ
Water
% Impervious Surface
UT to Hogans Creek
Roanoke 22 31 Class C N/A
Buffer Rules Buffer Rule Conditions(where applicable)
No N/A
Protected Species Presentb Mapped Histonc CAMA Essential Fishery Habitat
Properbesc AEC
No No No No
°Separate documentation attached as needed b See the attached Endangered Species Review Sheet for further information °When
Applicable See the attached Historic Review Letter for further information
PIPE RELOCATION INFORMATION
Site(Station) NIA Stream Type Intermittent
Existing Pipe 12 inch X 25 ft Replace 18 inch X 30 ft
Construction Pump around Dewatenng ABC aggregate or less
Method Device* intrusive device
Bunal Depth At least 20%of diameter of pipe EIC Plan
Date
Construction As soon as practicable Duration One week
Date
Impacts(ft) Thirty feet of permanent stream impacts and approximately 20 sf of temporary
stream impacts
Special A pump around will be utilized during the relocation The old pipe will be
Conditions removed All BMP practices will be utilized
Restoration Within 15 working days of the pipe relocation the natural stream contours will
Plan be restored and seeded
RCP=reinforced concrete pipe,CMP=Corrugated metal pipe CMPA=Corrugated metal pipe arch EIC=Erosion control *A less
intrusive dewatering device may be used in lieu of the one proposed

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 (including a pre construction meeting)with the Division Environmental
Officer
MITIGATION INFORMATION
Stream mitigation is not anticipated, as the impacts to any individual stream do not exceed 150 feet
Wetland mitigation is not anticipated, as wetland impacts do not exceed 0 10 acres and do not occur
in a unique natural wetland
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 Jerry Parker at [phone] Your time and effort are appreciated
Sincere!
/72.--624
Mr 7 Mills P E
Divri in Engineer Division 7
Enclosures
CC Amy Euless NC Division of Water Quality
Patty Eason,NCDOT
Tim Powers NCDOT
Barry Harrington NCDOT
NC Wetlands/401 Unit

o�oF warF�QG Office Use Only
Corps action ID no
®, o DWQ project no
Form Version 1 3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A Applicant Information
1 Processing
1 a Type(s)of approval sought from the
Corps ® Section 404 Permit ❑ Section 10 Permit
1 b Specify Nationwide Permit(NWP)number 14 or General Permit(GP)number
lc Has the NWP or GP number been verified by the Corps? ❑Yes ® No
1 d Type(s)of approval sought from the DWQ(check all that apply)
® 401 Water Quality Certification—Regular ❑ Non-404 Jurisdictional General Permit
❑401 Water Quality Certification—Express ❑ Ripanan Buffer Authorization
1 e Is this notification solely for the record For the record only for DWQ 401 For the record only for Corps Permit
because written approval is not required? Certification
❑ Yes ® No ❑ Yes No
if Is payment into a mitigation bank or in lieu fee program proposed for mitigation ❑Yes El No
of impacts? If so attach the acceptance letter from mitigation bank or in-lieu
fee program
1 g Is the project located in any of NC s twenty coastal counties If yes answer 1 h ❑Yes ® No
below
1 h Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑Yes ® No
2 Project Information
2a Name of project Lemons Road(SR 1104)
2b County Rockingham
2c Nearest municipality/town Summerfield NC
2d Subdivision name N/A
2e NCDOT only T I P or state WBS#17BP 7 R 32
protect no
3 Owner Information
3a Name(s)on Recorded Deed
3b Deed Book and Page No
3c Responsible Party(for LLC if
applicable)
3d Street address
3e City state zip
3f Telephone no
3g Fax no
3h Email address
Page l of 12
PCN Form—Version 1 3 December 10 2008 Version

4 Applicant Information(If different from owner)
4a Applicant is ®Agent ❑ Other specify
4b Name J M Mills
4c Business name Division Engineer NCDOT Division Seven
Of applicable)
4d Street address P 0 Box 14996
4e City state zip Greensboro NC 27415
4f Telephone no 336 334 3297
4g Fax no
4h Email address
5 Agent/Consultant Information(rf applicable)
5a Name Jerry Parker
5b Business name Division Environmental Supervisor
(if applicable)
5c Street address P 0 Box 14996
5d City state zip Greensboro NC 27415
5e Telephone no 336 256 2063
5f Fax no
5g Email address
Page 2 of 12
PCN Form—Version 1 3 December 10 2008 Version

B Project Information and Pnor Project History
1 Property Identification
1 a Property identification no (tax PIN or parcel ID) N/A
Latitude 36 2797243°N Longitude
1 b Site coordinates(in decimal degrees) 79 9618347°W
(DD DDDDDD) (DD DDDDDD)
1 c Property size N/A acres
2 Surface Waters
2a Name of nearest body of water(stream nver etc)to
proposed project Hogans Creek
2b Water Quality Classification of nearest receiving water Class C
2c River basin Roanoke
3 Project Descnption
3a Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application
Rural Residential
3b List the total estimated acreage of all existing wetlands on the property
0
3c List the total estimated linear feet of all existing streams(intermittent and perennial)on the property
90 feet
3d Explain the purpose of the proposed project
Relocate dnveway pipe to allow for the placement of guardrail associated with the replacement of Bridge#50 over
Hogans Creek
3e Describe the overall project in detail including the type of equipment to be used
A 12 ft X 12 driveway pipe will be removed and a new 30 ft X 18 pipe will be installed approximately 37 feet upstream
of the existing pipe The UT of Hogans Creek which the driveway pipe crosses runs parallel to Lemons Road and the
existing driveway would be blocked by the installation of guardrail associated with the replacement of the Lemons Road
bridge The guardrail is necessary as a safety measure for the new bridge The work is necessary in order to provide the
landowner access to their property because the installation of new guardrail would otherwise prohibit access The site will
be de watered utilizing a pump around with silt bags A new culvert will be buried at 20%of the diameter of the culvert
Equipment utilized will include backhoe and/or trackhoe
4 Junsdictional.Determinations
4a Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property/
project(including all prior phases) in the past?
Comments This area was reviewed for wetlands dunng the ❑Yes No [' Unknown
Low Impact Bridge Replacement Proces and was deemed to
be absent of wetlands
4b If the Corps made the jurisdictional determination what type ❑ preliminary 11] Final
of determination was made?
4c If yes who delineated the jurisdictional areas? Agency/Consultant Company
Name(if known) Other
4d If yes list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
Page 3 of 12
PCN Form—Version 1 3 December 10 2008 Version

5 Project History
5a Have permits or certifications been requested or obtained for ❑Yes 121 No ❑ Unknown
this project(including all prior phases)in the past?
5b 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 4 of 12
PCN Form—Version 1 3 December 10 2008 Version

C Proposed Impacts Inventory
1 Impacts Summary
1 a Which sections were completed below for your project(check all that apply)
❑Wetlands ® Streams-tributanes ❑ Buffers
❑ Open Waters ❑ Pond Construction
Page 5 of 12
PCN Form—Version 1 3 December 10 2008 Version

2 Wetland Impacts
tf there are wetland impacts proposed on the site then complete this question for each wetland area impacted
2a 2b 2c 2d 2e 2f
Wetland impact Type of junsdiction
number— Type of impact Type of wetland Forested (Corps 404 10 Area of impact
Permanent(P)or (if known) DWQ—non-404 other) (acres)
Temporary(T)
W7 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W2 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W3 ❑ P ❑T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W4 ❑ PDT
❑ Yes ❑ Corps
❑ No ❑ DWQ
W5 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W6 ❑ P❑T ❑ Yes ❑ Corps
❑ No ❑ DWQ
2g Total wetland impacts
2h Comments
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 impacted
3a 3b 3c 3d 3e 3f 3g
Stream impact Type of impact Stream name Perennial Type of junsdiction Average Impact
number (PER)or (Corps 404 10 stream length
Permanent(P)or intermittent DWQ—non-404 width (linear
Temporary(T) (INT)? other) (feet) feet)
Replacement of 30ft
25 ft culvert wrth UT to Hogans ❑ PER El Corps
permenent
Si ® P ®T 30 ft culvert Creek ® INT 121 DWQ
5-6 ft impacts
located 37 feet 20 ft temp
upstream of old impacts
culvert
S2 ❑ P ❑ T ID PER ❑ Corps
❑ INT ❑ DWQ
S3 ❑ P ❑T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S4 ❑ P ❑T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S5 ❑ PDT
❑ PER ❑ Corps
❑ INT ❑ DWQ
S6 ❑ P ❑T ❑ PER ❑ Corps
❑ INT ❑ DWQ
30 ft
permenent
3h Total stream and tnbutary impacts impacts
20 ft temp
impacts
3i Comments
Page 6 of 12
PCN Form-Version 1 3 December 10 2008 Version

4 Open Water Impacts
If there are proposed impacts to lakes ponds estuaries tnbutanes 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— (if applicable) Type of impact Waterbody type Area of impact(acres)
Permanent(P)or
Temporary(T)
01 ❑ P❑T
02 ❑ P❑T
03 [' PET
04 ❑ P❑T
4f Total open water impacts
4g Comments
5 Pond or Lake Construction
If pond or lake construction proposed then complete the chart below
5a 5b 5c 5d 5e
Wetland Impacts(acres) Stream Impacts(feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f Total
5g Comments
5h Is a dam high hazard permit required?
❑Yes ❑ No If yes permit ID no
5i Expected pond surface area(acres)
5j Size of pond watershed(acres)
5k Method of construction
6 Buffer Impacts(for DWQ)
If project will impact a protected npanan buffer then complete the chart below If yes then individually list all buffer impacts
below If any impacts require mitigation then you MUST fill out Section D of this form
6a
❑ Neuse CI Tar Pamlico ❑ Other
Project is in which protected basin? ❑Catawba ❑ Randleman
6b 6c 6d 6e 6f 6g
Buffer impact
number— Reason Buffer Zone 1 impact Zone 2 impact
Permanent(P)or for Stream name mitigation (square feet) (square feet)
Temporary(T) impact required?
B1 ❑ P❑ T ❑Yes
❑ No
B2 ❑ P❑T ❑Yes
❑ No
B3 ❑ P❑ T ❑Yes
❑ No
611 Total buffer impacts
6i Comments
Page 7 of 12
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
Impacts will be minimized by utilization of Best Management Practices and by performing work in the dry
lb Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Best Management Practices will be utilized during construction Pre-construction meeting with Environmental Superevisor mill
take place prior to commencing construction
2 Compensatory Mitigation for Impacts to Waters of the U S or Waters of the State
2a Does the project require Compensatory Mitigation for ❑ Yes ® No
impacts to Waters of the U S or Waters of the State?
2b If yes mitigation is required by(check all that apply) ❑ DWQ ❑ Corps
❑ Mitigation bank
2c If yes which mitigation option will be used for this
project? ❑ 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 rf Making a Payment to 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 mitigation stream temperature ❑warm ❑ cool ❑cold
4d Buffer mitigation requested(DWQ only) square feet
4e Ripanan wetland mitigation requested acres
4f Non-ripanan wetland mitigation requested acres
4g Coastal(tidal)wetland mitigation requested acres
4h Comments
5 Complete if Using a Permrttee Responsible Mitigation Plan
5a If using a permittee responsible mitigation plan provide a description of the proposed mitigation plan
Page 8 of 12
PCN Form—Version 1 3 December 10 2008 Version

6 Buffer Mrbgation(State Regulated Rrpanan Buffer Rules)—required by DWQ
6a Will the project result in an impact within a protected npanan buffer that requires ❑Yes ® No
buffer mitigation?
6b If yes then identify the square feet of impact to each zone of the npanan buffer that requires mitigation Calculate the
amount of mitigation required
6c 6d 6e
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (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 mitigation is proposed(e g payment to pnvate mitigation bank
permrttee responsible npanan buffer restoration payment into an approved in lieu fee fund)
6h Comments
Page 9 of 12
PCN Form—Version 1 3 December 10 2008 Version

E Stormwater Management and Diffuse Flow Plan(required by DWQ)
1 Diffuse Flow Plan
1 a Does the project include or is it adjacent to protected npanan buffers identified ❑ Yes 0 N
within one of the NC Ripanan Buffer Protection Rules?
lb If yes then is a diffuse flow plan included? If no explain why
❑ Yes ® No
Comments
2 Stormwater Management Plan
2a What is the overall percent imperviousness of this project? N/A%
2b Does this project require a Stormwater Management Plan? ❑Yes ® No
2c If this project DOES NOT require a Stormwater Management Plan explain why
2d If this project DOES require a Stormwater Management Plan then provide a brief narrative descnption of the plan
T
❑ Certified Local Government
2e Who will be responsible for the review of the Stormwater Management Plan? El DWQ Stormwater Program
® DWQ 401 Unit
3 Certified Local Government Stormwater Review
3a In which local government's jurisdiction is this project? N/A
El Phase II
3b Which of the following locally-implemented stormwater management programs H NSW
apply(check all that apply)
❑Water
Supply Watershed
❑ Other
3c Has the approved Stormwater Management Plan with proof of approval been ❑Yes ® No
attached?
4 DWQ Stormwater Program Review
❑ Coastal counties
El HQW
4a Which of the following state-implemented stormwater management programs apply ❑ ORW
(check all that apply) El Session Law 2006-246
❑ Other
4b Has the approved Stormwater Management Plan with proof of approval been
attached? ❑Yes ❑ No
5 DWQ 401 Unit Stormwater Review
5a Does the Stormwater Management Plan meet the appropriate requirements? El Yes El No
5b Have all of the 401 Unit submittal requirements been met? ❑Yes El No
Page 10 of 12
PCN Form—Version 1 3 December 10 2008 Version

F Supplementary Information
1 Environmental Documentation(DWQ Requirement)
la Does the project involve an expenditure of public(federal/state/local)funds or the Z Yes ❑ No
use of public(federal/state)land?
lb If you answered`yes to the above does the project require preparation of an
environmental document pursuant to the requirements of the National or State ❑Yes ® No
(North Carolina)Environmental Policy Act(NEPA/SEPA)?
1c If you answered`yes to the above has the document review been finalized by the
State Clearing House? (If so attach a copy of the NEPA or SEPA final approval
letter) ❑Yes ❑ No
Comments
2 Violations(DWQ Requirement)
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 Ripanan 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 violafion(s)
3 Cumulative Impacts(DWQ Requirement)
3a Will this project(based on past and reasonably anticipated future impacts)result in ❑Yes E)No
additional development which could impact nearby downstream water quality?
3b If you answered`yes to the above submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy If you answered no provide a short narrative description
4 Sewage Disposal(DWQ Requirement)
4a 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
NA
Page 11 of 12
PCN Form—Version 1 3 December 10 2008 Version

5 Endangered Species and Designated Critical Habitat(Corps Requirement)
5a Will this project occur in or near an area with federally protected species or ❑Yes El No
habitat?
5b Have you checked with the USFWS concerning Endangered Species Act ®Yes ❑ 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 Species or Designated Critical
Habitat?
US Fish and Wildlife Web Site
6 Essential Fish Habitat(Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitat? ❑Yes ® No
6b What data sources did you use to determine whether your site would impact Essential Fish Habitat?
N/A
7 Historic or Prehistoric Cultural Resources(Corps Requirement)
7a Will this project occur in or near an area that the state federal or tnbal
governments have designated as having historic or cultural preservation ❑Yes El No
status(e g National Historic Trust designation 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?
National Histonc Register Web Site
8 Flood Zone Designation(Corps Requirement)
8a Will this project occur in a FEMA-designated 100 year fioodplain? ❑Yes ® No
8b If yes explain how project meets FEMA requirements
8c What source(s)did you use to make the floodplain determination? NC Floodplain Mapping Information System
J M Mtlls Air 9 28-12
Applicant/Agent s Printed Name App cant/Agent s Signature Date
(Agents •gnature is v id only if an authonzation letter from the applicant
is provided)
Page 12 of 12
PCN Form—Version 1 3 December 10 2008 Version

17BP 7 R 32
Rockingham Bridge#780050
Construction Sequence for replacing driveway pipe at left of STA 11+60
1 Install coffer dams
2 Remove existing 12 inch CMP and grade ditch
3 Install new 18 inch CMP or RCP
4 Backfill new pipe and construct new driveway
5 Remove coffer dams and pump
6 Seed and mulch disturbed areas

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Name EWSBORO Location 036 2715044 N 079 9578112 W
Date 9/28/2012 Caption.Lemons Road(SR 1104)
Scale 1 inch equals 2000 feet Rockingham County
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