20211027 Ver 1_Bridge 560145 Madison MCDC signed_20211210

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MINIMUM CRITERIA DETERMINATION CHECKLIST

The following questions provide direction in determining when the Department is
required to prepare environmental documents for state-funded construction and
maintenance activities. Answer questions for Parts A through C by checking either yes
or no. Complete Part D of the checklist when Minimum Criteria Rule categories #8, 12i,
or #15 are used.

TIP Project No.:

State Project No.: 17BP.13.R.172

Project Location: Bridge 560145, SR 1151 over Big Pine Creek, Madison County

Project Description: Replace a single span bridge with a 24’x7’ three-sided culvert
in the same location.

Anticipated Permit or Consultation Requirements: NWP 14 permit required for
footings and bank stabilization.

Special Project Information: Project area surveyed and no threatened or
endangered species will be affected. Trout waters.

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PART A: MINIMUM CRITERIA

YES

NO
Item 1 to be completed by the Engineer.
1. Is the proposed project listed as a type and class of activity allowed under
the Minimum Criteria Rule in which environmental documentation is not
required?
X

If the answer to number 1 is “no”, then the project does not qualify as a
minimum criteria project. A state environmental assessment is required.

If yes, under which category? ____9_____
If either category #8, #12i, or #15 is used complete Part D of this checklist.

PART B: MINIMUM CRITERIA EXCEPTIONS

Items 2 – 4 to be completed by the Engineer.
2. Could the proposed activity cause significant changes in land use
concentrations that would be expected to create adverse air quality
impacts?
X

3. Will the proposed activity have secondary impacts or cumulative impacts
that may result in a significant adverse impact to human health or the
environment?
X

4. Is the proposed activity of such an unusual nature or does the proposed
activity have such widespread implications, that an uncommon concern
for its environmental effects has been expressed to the Department?
X

Item 5-8 to be completed by Division Environmental Officer.
5. Does the proposed activity have a significant adverse effect on wetlands;
surface waters such as rivers, streams, and estuaries; parklands; prime or
unique agricultural lands; or areas of recognized scenic, recreational,
archaeological, or historical value?
X

6. Will the proposed activity endanger the existence of a species on the
Department of Interior's threatened and endangered species list? X

7. Could the proposed activity cause significant changes in land use
concentrations that would be expected to create adverse water quality or
ground water impacts?
X

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YES NO
8. Is the proposed activity expected to have a significant adverse effect on
long-term recreational benefits or shellfish, finfish, wildlife, or their
natural habitats
X

If any questions 2 through 8 are answered “yes”, the proposed project may not qualify as a
Minimum Criteria project. A state environmental assessment (EA) may be required. For
assistance, contact:

Manager, Project Development and Environmental Analysis Branch
P. O. Box 25201
Raleigh, NC 27611
(919) 733 –3141
Fax: [phone]

PART C: COMPLIANCE WITH STATE AND FEDERAL REGULATIONS

Items 9- 12 to be completed by Division Environmental Officer. YES NO
9. Is a federally protected threatened or endangered species, or its
habitat, likely to be impacted by the proposed action?
X

10. Does the action require the placement of temporary or permanent
fill in waters of the United States?
X

11. Does the project require the placement of a significant amount of
fill in high quality or relatively rare wetland ecosystems, such as
mountain bogs or pine savannahs?
X

12. Is the proposed action located in an Area of Environmental
Concern, as defined in the coastal Area Management Act?
X

Items 13 – 15 to be completed by the Engineer.
13. Does the project require stream relocation or channel changes? X

Cultural Resources
14. Will the project have an “effect” on a property or site listed on the
National Register of Historic Places?
X

15. Will the proposed action require acquisition of additional right of
way from publicly owned parkland or recreational areas?
X

Questions in Part “C” are designed to assist the Engineer and the Division Environmental
Officer in determining whether a permit or consultation with a state or federal resource
agency may be required. If any questions in Part “C” are answered “yes”, follow the
appropriate permitting procedures prior to beginning project construction.
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PART D:( To be completed when either category #8, #12i, or #15 of the rules are
used.) N/A

Items 16- 22 to be completed by Division Environmental Officer.

16. Project length:

17. Right of Way width:

18. Project completion date:

19. Total acres of newly disturbed ground
surface:

20. Total acres of wetland impacts:

21. Total linear feet of stream impacts:

22. Project purpose:

If Part D of the checklist is completed, send a copy of the entire checklist document to:

State Roadside Environmental Engineer
Mail Service Center 1557
Raleigh, NC 27699-1557
[phone]
Email: [e-mail]

Reviewed by: Date:
Division Bridge Program Manager

Date:
Division Environmental Officer

Dec 10, 2021
Dec 10, 2021