20130935 Ver 1_Application_20130903

STATE OF NORTH CAROLINA
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DEPARTMENT OF TRANSPORTATION
PAT L. MCCRORY
GOVERNOR
September 3, 2013
U. S. Army Corps of Engineers
Regulatory Field Office
3331 Heritage Trade - Drive, Suite 105
Wake Forest, NC 27587
ATTN: Mr. Eric Alsmeyer
NCDOT Division 5 Coordinator
ANTHONY J. TATA
SECRETARY
X01 30935
SUBJECT: Application for Section 404 Nationwide Permits 13, 23, and 33, Section 401 Water
Quality Certification, and Tar - Pamlico Riparian Buffer Authorization for the
replacement of Bridge No. 53 over Sandy Creek on SR 1523 (Southerland Mill Road),
Vance County, North Carolina. Federal Aid Project No. BRZ — 1523(6), TIP No. B -4827.
Debit $240.00 from WBS Element No. 38597.1.1
Please find enclosed the Pre - construction Notification (PCN), U.S. Army Corps of Engineers (USACE)
Jurisdictional Determination, U.S. Fish and Wildlife Service (USFWS) concurrence letter, N.C. Division
of Water Resources (NCDWR; formerly Division of Water Quality [NCDWQ]) State Stormwater Permit,
Stormwater Management Plan, permit drawings, buffer drawings, and roadway design plans for the
subject project. A Programmatic Categorical Exclusion (PCE) was completed for this project in March
2012 and distributed shortly thereafter. Additional copies are available upon request.
The proposed let date for this project is February 18, 2014, with a let review date of December 31, 2013.
However, the let date may advance as additional funds become available.
A copy of this permit application will be posted on the NCDOT Website at:
https:/ /connect nedot gov/ resources / Environmental /Pages /default.aVx. Thank you for your assistance with
this project. If you have any questions or need additional information, please contact Jim Mason at either
jsmason @ncdot.gov or (919) 707 -6136.
Sincerely,
Deborah . Barbour, P.E.
Director of Preconstruction
cc: NCDOT Permit Application Standard Distribution List
MAILING ADDRESS:
PHYSICAL ADDRESS:
NC DEPARTMENT OF TRANSPORTATION TELEPHONE 919 - 707 -6100
Century Center - Building B
PROJECT DEVELOPMENT AND ENVIRONMENTAL ANALYSIS
1020 Birch Ridge Dr
NATURAL ENVIRONMENT SECTION FAX [phone]
Raleigh, NC 27610 -4328
1598 MAIL SERVICE CENTER
RALEIGH NC 27699 -1598 IY£8S77E., IV{VIY.NCDOT. ORG

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Office Use Only:
Corps action ID no.
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
1b. Specify Nationwide Permit (NWP) number: 13 23 33 or General Permit (GP) number:
1 c.
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 ® Riparian Buffer Authorization
1 e
is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes ® No
For the record only for Corps Permit:
❑ Yes ® No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
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 Environmental Concern (AEC)?
❑ Yes
® No
2.
Project Information
2a.
Name of project:
Replacement of Bridge No. 53 over Sandy Creek on SR 1523 (Southerland Mill Rd)
2b.
County:
Vance
2c
Nearest municipality / town:
Vicksboro
2d.
Subdivision name:
not applicable
2e.
NCDOT only, T.I.P. or state
project no:
B-4827
3.
Owner Information
3a.
Name(s) on Recorded Deed-
North Carolina Department of Transportation
3b.
Deed Book and Page No.
not applicable
3c.
Responsible Party (for LLC if
applicable):
not applicable
3d.
Street address:
1598 Mail Service Center
3e.
City, state, zip:
Raleigh, NC 27699 -1598
3f.
Telephone no
(919) 707 -6136
3g.
Fax no.:
(919) 212 -5785
3h. Email address:
jsmason @ncdot.gov

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ❑ Other, specify -
4b. Name.
not applicable
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address,
5. Agent/Consultant Information (if applicable)
5a. Name:
not applicable
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no..
5f. Fax no.:
5g. Email address:

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
not applicable
Latitude: 36.2902 Longitude: - 78.2909
1b. Site coordinates (in decimal degrees):
(DD.DDDDDD) (- DD.DDDDDD)
1c. Property size:
0.6 acres
2. Surface Waters
2a Name of nearest body of water (stream, river, etc.) to
Sandy Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
B NSW +
2c. River basin:
Tar Pamlico
3. Project Description
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:
SR 1523 is classified as a Rural Minor Collector. Land use within the vicinity includes Forested Land, Agriculture,
Silviculture, and Low- Density Residential.
3b. List the total estimated acreage of all existing wetlands on the property:
0.01 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
273 linear feet
3d. Explain the purpose of the proposed project:
To replace a structurally deficient and functionally obsolete bridge
3e. Describe the overall project in detail, including the type of equipment to be used:
The project consists of replacing the existing six -span, 121 -foot long bridge with a three -span, 142.5 -foot bridge. The new
structure will be constructed on the existing alignment. Traffic will be maintained via off -site detour. Standard road
building equipment, such as trucks, dozers, and cranes will be used.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property
® Yes ❑ No ❑ Unknown
/ project (including all prior phases) in the past?
Comments: JD obtained 11/12/2009 (Action ID 2009 - 01485)
4b. If the Corps made the jurisdictional determination, what type
® Preliminary ❑ Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency /Consultant Company: NCDOT
Name (if known): Principal Investigator: Lindsey Riddick
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
November 12, 2009
S. Project History
5a. Have permits or certifications been requested or obtained
❑ Yes ® No ❑ Unknown
for 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.

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. 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 impacted.
2a.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
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
Site 2 ® P ❑ T
Permanent Fill
Headwater Forest
® Yes
❑ No
® Corps
❑ DWQ
<0.01
Site 2 ❑ P ®T
Temporary Fill
Headwater Forest
® Yes
E] No
® Corps
El
<0.01
Site ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
Site ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
Site ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
Site ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
<0.01 Perm.
<0.01 Temp.
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
Average
Impact
number -
(PER) or
jurisdiction
stream
length (linear
Permanent (P) or
intermittent
(Corps - 404, 10
width
feet)
Temporary (T)
(INT)?
DWQ — non -404,
(feet)
other)
Site 1 ® P ❑ T
Bank
Stabilization
Sandy Creek
® PER
❑ INT
® Corps
❑ DWQ
46
32
Temp. Rock
® PER
® Corps
Site 1 ❑ P ® T
Causeway/
Sandy Creek
El INT
❑DWQ
46
23
Bent Removal
Site 2 ® P ❑ T
Bank
Stabilization
UT of Sandy
CreekS((S) ream
El PER
® INT
®Corps
❑ DWQ
2-3
21
UT of Sandy
Corps
Site 2 ❑ P ® T
Temporary Fill
Creek (Stream
® INT
2 -3
6
SA)
Site ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
Site ❑ P ❑ T
❑ PER
❑ INT
❑ Corps
❑ DWQ
3h. Total stream and tributary impacts
53 Perm
29 Temp

3i. Comments:
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 indii idually list all open water impacts below.
4a.
Open water
impact number —
Permanent (P)
or Temporary T
4b.
Name of
waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody type
4e.
Area of impact (acres)
01 ❑P ❑T
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
0. Total open water impacts
0 Permanent
0 Temporary
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.
Pond ID
number
5b.
Proposed use or
purpose of pond
5c.
Wetland Impacts (acres)
I
5d.
Stream Impacts (feet)
5e.
Upland
(acres)
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 riparian 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
®Tar- Pamlico
❑Other:
Project is in which protected basin?
❑ Catawba
❑ Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number —
Reason for impact
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
Stream name
mitigation
(square feet)
(square feet)
Temporary T
required?
Site 1 ® P ❑ T
Bridge
Sandy Creek
® Yes s
3,221
1,049
Site 1 ® P ❑ T
Road Crossing
Sandy Creek
® Nos
0
144
❑P ❑T
El Yes
❑ No
6h. Total buffer impacts
3,221
1,193
6i. Comments: The UT of Sandy Creek (Stream SA) is not buffered

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
An off -site detour will be employed; The new bridge will be longer than the existing; A special cut ditch will be installed
from STA. -L- 17 +00 to 18 +00 LT; A lateral base ditch will be installed from STA. -L- 16 +50 to 17 +00 LT; Stormwater from
the bridge deck will be collected via drop inlets, piped, and then treated through a Class B rip rap pad in the southwest
quadrant of the project, outside of the riparian buffer.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
NCDOT Best Management Practices for Construction and Maintenance Activities will be implemented during the removal
of the existing bridge; Best Management Practices for the Protection of Surface Waters will be employed; Due to the
project being in a buffer basin, Design Standards in Sensitive Watersheds will be Employed.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters 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
If no, explain: Permanent wetland impacts are minimal and
permanent stream impacts are in the form of bank
stabilization and are less than 150 lin. ft. along either stream
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which mitigat ion 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: not applicable
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
3c. Comments:
4. Complete if 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
i4c. If using stream mitigation, stream temperature.
❑ warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only):
0 square feet
4e Riparian wetland mitigation requested:
0 acres
4f. Non - riparian wetland mitigation requested:
0 acres
4g. Coastal (tidal) wetland mitigation requested:
0 acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.

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 mitigation?
❑ 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 mitigation required.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
0
6g If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments:

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 riparian buffers identified
® Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If not, explain why.
® Yes ❑ No
Comments: See attached buffer permit drawings.
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 description of the plan:
See attached permit drawings.
❑ Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
® DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
not applicable
❑ Phase II
El
3b. Which of the following locally - implemented stormwater management programs
El ❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes j-' ❑ No
attached?
4. DWQ Stormwater Program Review
❑ Coastal counties
4a. Which of the following state - implemented stormwater management programs apply
❑ HQW
E] ORW
(check all that apply):
❑ Session Law 2006 -246
® Other: B NSW +; upstream of
ORW waters
4b. Has the approved Stormwater Management Plan with proof of approval been
® Yes ❑ No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No N/A
5b. Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No N/A

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal /state/local) funds or the
® Yes ❑ No
use of public (federal /state) land?
1 b. 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
®Yes E] No
letter.)
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 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 reasonably anticipated future impacts) result in
❑ Yes
additional development, which could impact nearby downstream water quality?
® No
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.
Due to the minimal transportation impact resulting from this bridge replacement, this project will neither influence nearby
land uses nor stimulate growth. Therefore, a detailed indirect or cumulative effects study will not be necessary.
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.
not applicable
10

S. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. 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 Species Act
® Yes ❑ No
impacts?
® Raleigh
5c. If yes, ind icate the USFWS Field Office you have contacted.
El Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC Natural Heritage Program data, USFWS website, NCDOT field surveys. USFWS concurrence received June 5, 2013
(see attached letter).
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?
NMFS County Index c
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes ® 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?
NEPA Documentation
B. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA- designated 100 -year floodplain?
® Yes ❑ No
8b. If yes, explain how project meets FEMA requirements: NCDOT Hydraulics Unit coordination with FEMA
8c. What source(s) did you use to make the floodplain determination? FEMA Maps
Deborah M. Barbour, P.E.,
1 ���
�q 03 -13
D e
Director of Preconstruction
Applicant/Agent's Printed Name
A licant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
is provide d
11

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action ID. 2009 -01485 County: Vance and Warren U.S.G.S. Quad: Vicksboro
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Property Owner /Agent: NCDOT; Division of Highways
Address: ATTN: Gregory J. Thorpe, Ph.D
1598 Mail Service Center
Raleigh, North Carolina 27699 -1598
Telephone No.: (919) 431 -6602 (Lindsey Riddiek)
Property description: Study area for TIP #B -4827; On SR 1523 (Southerland Mill Road), BR 53 over Sandy Creek, southeast of
Henderson, NC.
Size (acres) N/A
Nearest Waterway Sandy Creek
USGS HUC 03020101
Preliminary Determination
Nearest Town Henderson
River Basin Tar
Coordinates N 36.9202 W - 78.2909
X Based on preliminary information, there may be waters of the U.S. including wetlands on the above described project area. We strongly
suggest you have this property inspected to determine the extent of Department of the Army (DA) jurisdiction. To be considered final, a
jurisdictional determination must be verified by the Corps. This preliminary determination is not an appealable action under the
Regulatory Program Administrative Appeal Process ( Reference 33 CFR Part 331).
The property is located in one of the 20 Coastal Counties subject to regulation under the Coastal Area Management Act (CAMA). You
should contact the Division of Coastal Management in Washington, NC, at (252) 946 -6481 to determine their requirements.
Placement of dredged or fill material within waters of the US and /or wetlands without a Department of the Army permit may constitute a
violation of Section 301 of the Clean Water Act (33 USC § 1311). If you have any questions regarding this determination and /or the Corps
regulatory program, please contact Eric Alsmeyer at 919 -554 -4884, Ext. 23.
Remarks
9/15/2009 field inspection. The drawing, T.I.P. No. B -4827 Figure 3 (copy att.) submitted on 7/27/20098, generally depicts the
aquatic features of the US within the subject study area.
Corps Regulatory Official Date: 11/12/2009 Determination Expiration Date: 11/12/2014
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we continue to do so, please
complete the Customer Satisfaction Survey located at our website at littp:/h-egulatory.usacesurveN/.COIII/ to complete the survey online.

ATTACHMENT
PRELIMINARY JURISDICTIONAL DETERMINATION FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JURISDICTIONAL
DETERMINATION (JD): 1►LI�"Oi
B. NAME AND ADDRESS OF PERSON REQUESTING PRELIMINARY JD:
Lindsey Riddick
NCDOT
1598 Mail Service Center
Raleigh, NC 27699 -1598
C. DISTRICT OFFICE, FILENAME, AND N MICR •CESAW -RGR;
/VCpdT /P - y�a7 S- 15x3 see / ,l/R41 was l ac 'q - o I y85
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
B -4827, SR 1523 over Sandy Creek, Vance & Warren Counties
(USE THE ATTACHED TABLE TO DOCUMENT MULTIPLE WATERBODIES
AT DIFFERENT SITES)
State: North Carolina County /parish /borough: Vance & Warren City:
Henderson
Center coordinates of site (lat/long in degree decimal format):
Lat. 36.290216 ° N, Long. - 78.290913 ° W.
Universal Transverse Mercator: zone 17
Name of nearest waterbody: Sandy Creek
Identify (estimate) amount of waters in the review area:
Non - wetland waters: 640' linear feet: varies width (ft) and /or
acres.
Cowardin Class: C�
Stream Flow: intermittent and perennial
Wetlands: 0.17 acres.
Cowardin Class: Forested
Name of any water bodies on the site that have been identified as Section 10
waters:
Tidal:
Non - Tidal:
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT
APPLY):
❑ Office (Desk) Determination. Date:
Field Determination. Date(s): V /� '194q
1101,

1. The Corps of Engineers believes that there may be jurisdictional waters of the
United States on the subject site, and the permit applicant or other affected party
who requested this preliminary JD is hereby advised of his or her option to
request and obtain an approved jurisdictional determination (JD) for that site.
Nevertheless, the permit applicant or other person who requested this
preliminary JD has declined to exercise the option to obtain an approved JD in
this instance and at this time.
2. In any circumstance where a permit applicant obtains an individual permit, or
a Nationwide General Permit (NWP) or other general permit verification requiring
"pre- construction notification" (PCN), or requests verification for a non - reporting
NWP or other general permit, and the permit applicant has not requested an
approved JD for the activity, the permit applicant is hereby made aware of the
following: (1) the permit applicant has elected to seek a permit authorization
based on a preliminary JD, which does not make an official determination of
jurisdictional waters; (2) that the applicant has the option to request an approved
JD before accepting the terms and conditions of the permit authorization, and
that basing a permit authorization on an approved JD could possibly result in less
compensatory mitigation being required or different special conditions; (3) that
the applicant has the right to request an individual permit rather than accepting
the terms and conditions of the NWP or other general permit authorization; (4)
that the applicant can accept a permit authorization and thereby agree to comply
with all the terms and conditions of that permit, including whatever mitigation
requirements the Corps has determined to be necessary; (5) that undertaking
any activity in reliance upon the subject permit authorization without requesting
an approved JD constitutes the applicant's acceptance of the use of the
preliminary JD, but that either form of JD will be processed as soon as is
practicable; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Corps
permit authorization based on a preliminary JD constitutes agreement that all
wetlands and other water bodies on the site affected in any way by that activity
are jurisdictional waters of the United States, and precludes any challenge to
such jurisdiction in any administrative or judicial compliance or enforcement
action, or in any administrative appeal or in any Federal court; and (7) whether
the applicant elects to use either an approved JD or a preliminary JD, that JD
will be processed as soon as is practicable. Further, an approved JD, a proffered
individual permit (and all terms and conditions contained therein), or individual
permit denial can be administratively appealed pursuant to 33 C.F.R. Part 331,
and that in any administrative appeal, jurisdictional issues can be raised (see 33
C.F.R. 331.5(a)(2)). If, during that administrative-appeal, it becomes necessary
to make an official determination whether CWA jurisdiction exists over a site, or
to provide an official delineation of jurisdictional waters on the site, the Corps will
provide an approved JD to accomplish that result, as soon as is practicable.
This preliminary JD finds that there "maybe" waters of the United States on the
subject project site, and identifies all aquatic features on the site that could be .
affected by the proposed activity, based on the following information:
2

SUPPORTING DATA. Data reviewed for preliminary JD (check all that apply
- checked items should be included in case file and, where checked and
requested, appropriately reference sources below):
® Maps, plans, plots or plat submitted by or on behalf of the
applicant/consultant:
® Data sheets prepared /submitted by or on behalf of the
applicant/consultant.
❑ Office concurs with data sheets /delineation report.
❑ Office does not concur with data sheets /delineation report.
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
® U.S. Geological Survey map(s). Cite scale & quad name: 1:24000;.
® USDA Natural Resources Conservation Service Soil Survey.
Citation:
® National wetlands inventory map(s). Cite name:SAW shapefile.
❑ State /Local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100 -year Floodplain Elevation is: (National Geodectic Vertical Datum
of 1929)
❑ Photographs: ❑ Aerial (Name & Date):
or ❑ Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not
necessarily been verified by the Corps and should not be relied upon for
later jurisdictional determinations.
&4-141 - 16-60-0
Signature and a of
Regulatory Project Manager
(REQUIRED)
3
7h,/°%
ignature and a e of
person requesting preliminary JD
(REQUIRED, unless obtaining
the signature is impracticable)

* WB is connected to Sandy creek by a non-404-jurisdictional discrete surface drainage
feature.
4
Estimated
amount of
Class of
Site
Latitude
Longitude
Cowardin
aquatic
aquatic
number
Class
resource in
resource
review area
SA
36.290486
- 78.291042
200'
Intermittent
stream
upstream of
driveway
pipe,
perennial
downstream
WA
36.290992
- 78.291199
0.10 ac
Headwater
forest wetland
WB*
36.291152
- 78.290613
0.07 ac
Headwater
forest wetland
Sandy
36.290240
- 78.290913
200
Perennial
Creek
stream
* WB is connected to Sandy creek by a non-404-jurisdictional discrete surface drainage
feature.
4

iMENT OF TN
�p ya
O � 9
N b
7
�gaCH 3
United States Department ®f the ff ntelrio r
FISH AND WILDLIFE SERVICE
Raleigh Field Office
Post Office Box 33726
Raleigh, North Carolina 27636 -3726
June 5, 2013
Gregory J. Thorpe, Ph.D.
North Carolina Department of Transportation
Project Development and Environmental Analysis
1598 Mail Service Center
Raleigh, North Carolina 27699 -1598
Dear Dr. Thorpe:
This letter is in response to your letter of May 22, 2013 which provided the U.S. Fish and
Wildlife Service (Service) with the biological conclusion of the North Carolina Department of
Transportation that the replacement of Bridge No. 53 on SR 1523 (County Line Road) over
Sandy Creek in Vance /Warren County (TIP No. B -4827) may affect, but is not likely to
adversely affect the federally endangered dwarf wedgemussel (Alasmidonta heterodon) and Tar
River spinymussel (Elliptio steinstansana). These comments are provided in accordance with
Section 7 of the Endangered Species Act (ESA) of 1973, as amended (16 U.S.C. 1531- 1543).
The Service previously provided concurrence with this biological conclusion with a letter dated
November 9, 2009. However, detailed project designs were not available at the time. Since
then, project design has been completed, and it has been determined that additional impacts may
occur with a temporary causeway, with interior bent removal, and from permanent bank
stabilization.
According to information provided, mussel surveys were conducted at the project site on June
25, 2009 and April 19, 2013. The 2009 survey extended 100 meters upstream and 400 meters
downstream of SR 1523, and the 2013 survey extended 100 meters upstream and 200 meters
downstream of SR 1523. Neither of the federally listed species was found, but good quality
habitat for the two species was present. In the 2009 survey, the Tar River spinymussel species
associate Atlantic pigtoe (Fusconaia masoni) was observed. The nearest known occurrence of
either listed species is a record for the Tar River spinymussel approximately 25 km downstream.
Based on the mussel survey results and other available information, the Service concurs with
your determination that the proposed project may affect, but is not likely to adversely affect the
dwarf wedgemussel and Tar River spinymussel. We believe that the requirements of Section
7(a)(2) of the ESA have been satisfied. We remind you that obligations under Section 7
consultation must be reconsidered if: (1) new information reveals impacts of this identified
action that may affect listed species or critical habitat in a manner not previously considered in
this review; (2) this action is subsequently modified in a manner that was not considered in this
review; or (3) a new species is listed or critical habitat determined that may be affected by this
identified action.

The Service appreciates the opportunity to review this project. If you have any questions
regarding our response, please contact Mr. Gary Jordan at (919) 856 -4520 (Ext. 32).
Sincerely,
Pete Benjamin
Field Supervisor
Electronic copy: Eric Alsmeyer, USACE, Wake Forest, NC
Travis Wilson, NCWRC, Creedmoor, NC
Felix Davila, FHWA, Raleigh, NC
Jim Mason, NCDOT, Raleigh, NC

/V) vi e.", AZjL)
NODE R
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Acting Director Secretary
June 26, 201
David S. Chang, Ph.D., P.E. `; E E I V rt ,
State Hydraulics Engineer
1590 Mail Service Center
Raleigh NC 27699 -1590 JUN 2 8 2013
SUBJECT: Permit No. SW5130502
B -4827 Bridge Replacement DIVISION OF cz L N 1.1
Southerland Mill Rd (SRI 52' HYD�tA�LI Ul�f.i
Stormwater Project — Sandy Creek
Vance County
Mr. Chang:
The Raleigh Regional Office received the Stormwater Application for the Replacement of Bridge
No. 53 on SR 152' ) in Vance County on May 1, 2013 with additional information dated received May 17,
2013. Staff review of the plans and specifications has determined that the project, as proposed, will
comply with the Stormwater Regulations set forth in Title 15A NCAC 2H.1000. We are forwarding
Permit No.SW5130502, dated June 26, 20131, to you.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
conditions and limitations as specified herein.
If any parts, requirements or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within thirty (3 )0) days following receipt of
this permit. This request must be in the form of a written petition, conforming to Chapter 150B of the
North Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service
Center, Raleigh, NC 27699 -6714. Unless such demands are made this permit shall be final and binding.
If you have any questions, or need additional information concerning this matter, please contact
me at (919) 791 -4252.
Sincerely,
S. Daniel Smith, Supervisor
Raleig Regional Office
ffice
Surface Water Protection Section
cc: Transportation Permitting Unit
RRO -file
North Carolina Division of Water Quality, Winston -Salem Regional Office
Location: 585 Waughtown St. Winston - Salem, North Carolina 27107 One
Phone. 336 - 771 -50001 FAX: 336 - 77146301 Customer Service: 1- 877 - 623 -6748 NorthCarolina
Internet: www.ncwaterguality.org ¢f,yv�y //
An Equal Opportunity 1 Affirmative Action Employer at ally

A �1;w
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Acting Director Secretary
STATE STORMWATER MANAGEMENT PERMIT
OTHER DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of
North Carolina as amended, and other applicable Laws, Rules and Regulations
PERMISSION IS HEREBY GRANTED TO
NCDOT Hydraulics Unit
Replace Bridge no. 53 (TIP B -4827)
SR 1523, Vance County
FOR THE
construction, operation and maintenance of a 21,344.4 square feet (0.49 acres) of
impervious surface with an increase of 3049.2 square feet (0.07 acres) of bridge and
roadway in compliance with the provisions of 15A NCAC 2H .1000 and S.L. 2006 -246
(hereafter referred to as the "stormwater rules') and the approved stormwater
management plans and specifications, and other supporting data as attached and on
file with and approved by the Division of Water Quality and considered a part of this
permit.
The Permit shall be effective from the date of issuance until rescinded and shall be
subject to the following specific conditions and limitations:
I. DESIGN STANDARDS
This permit covers the construction of 21,344.4 square feet (0.49 acres) of built -
upon area for bridge and roadway.
2. Approved plans and specifications for projects covered by this permit are
incorporated by reference and are enforceable parts of the permit.
3. The only runoff conveyance systems allowed are: 1) deck drains and rip rap
pads ( rip rap pads are to be installed outside of the riparian buffer), 2) for the
northwest quadrant a ditch with Class '1' rip rap (due to steep slopes), and 3)
vegetated conveyances such as swales with minimum side slopes of 3:1 (H:V) to
the maximum extent practical as defined in the stormwater rules and approved
by the Division.
4. All swales shall that discharge into a wetland shall do so at a non - erosive velocity
for the 10 year storm.
II. SCHEDULE OF COMPLIANCE
The permittee is responsible for verifying that the proposed built -upon area does
not exceed the allowable built -upon area.
Page 1 of 4

• SW5130502
2. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements. The permittee
shall provide copies of revised plans and certification in writing to the Director
that the changes have been made.
3. This project may not be sold or subdivided in whole or in part without first
receiving a permit modification from the Division.
4. Filling in or piping of any vegetative conveyances (ditches, swales, etc.)
associated with the permitted development, except for average driveway
crossings, is strictly prohibited by any persons.
5. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to the approved plans, regardless of size.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area.
e. Further subdivision, acquisition, or sale of the project area in whole or in
part. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval was sought.
f. Filling in, altering or piping any vegetative conveyance shown on the
approved plan.
8. Swales and other vegetated conveyances shall be constructed as proposed in
the permit application dated received February 26, 2013 with additional
information dated received March 4, 2013, and be operational for their intended
use prior to the construction of any built -upon surface.
9. During construction, erosion shall be kept to a minimum and any eroded areas of
the swales or other vegetated conveyances will be repaired immediately.
10. The permittee shall at all times provide the operation and maintenance
necessary to operate the permitted stormwater management systems at optimum
efficiency to include:
a. Inspections
b. Sediment removal.
c. Mowing, and re- vegetating of the side slopes.
d. Immediate repair of eroded areas.
e. Maintenance of side slopes in accordance with approved plans and
specifications.
11. Within 30 days of completion of the project, the permittee shall certify in writing
that the project has been constructed in accordance with the approved plans.
Page 2 of 4

SW5130502
12. The permittee shall submit all information requested by the Director or his
representative within the time frame specified in the written information request.
111. GENERAL CONDITIONS
This permit is not transferable to any person or entity except after notice to and
approval by the Director. The Director may require modification or revocation and
re- issuance of the permit to change the name and incorporate such other
requirements as may be necessary. In the event of a name or ownership
change, a completed Name /Ownership Change form, signed by both parties,
must be submitted to the Division of Water Quality accompanied by the
supporting documentation as listed on page 2 of the form. The approval of this
request will be considered on its merits, and may or may not be approved.
2. The permittee is responsible for compliance with all permit conditions until the
Director approves a transfer of ownership. Neither the sale of the project nor the
transfer of common areas to a third party, such as a homeowner's association,
constitutes an approved transfer of the stormwater permit.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to an enforcement action by the Division of Water Quality,
in accordance with North Carolina General Statutes 143- 215.6A to 143- 215.6C.
4. The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit
as allowed by the laws, rules, and regulations contained in Session Law 2006-
246, Title 15A of the North Carolina Administrative Code, Subchapter 2H.1000;
and North Carolina General Statute 143 -215.1 et. al.
5. In the event that the facilities fail to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by the Division, such as the construction of
additional or replacement stormwater management systems.
6. The permittee grants permission to DENR Staff to enter the property during
normal business hours, for the purpose of inspecting all components of the
stormwater management facility.
7. The permit issued shall continue in force and effect until revoked or terminated.
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and re- issuance, or
termination does not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the swales
must follow the guidelines established in the North Carolina Department of
Transportation's BMP Manual.
9. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
10. The issuance of this permit does not preclude the Permittee from complying with
Page 3 of 4

` SW5130502
11. any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state and federal), which have jurisdiction.
12. The permittee shall notify the Division in writing of any name, ownership or
mailing address changes at least 30 days prior to making such changes.
Permit issued this the 26th day of June, 2013.
NORITH CAROLINA ENVIRONMENTAAL�MANAGEMENT COMMISSION
foi• Thomas A. Ree er, Acting DirectoY
Division of Wat6r Quality
By Authority of the Environmental Management Commission
Page 4 of 4

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