20140101 Ver 1_Application_20140130

PAT MCCRORY
GOVERNOA
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STATE OF NORTH CAROLINA
DEPAR'I'MENT OF TRANSPORTATTON
January 30, 2014
SUBJECT: Stokes County— SR 1144 Statesville Blvd.
WBS project no.: 9B208511
Mr. John Thomas
US Army Corps of Engineers
3331 Heritage Trade Dr.
Suite 105
Wake Forest, NC 27615
Dear Mr. Thomas,
ANTHONY J. TATA
SECRETARY
We are requesting a Nationwide 3 permit for a pipe replacement on Pratt Road (SR 1144) in Stokes. [ have
attached a pre-construction notification application with supporting documentation. The failure is
endangering the road, and we need to proceed quickly with the repair. We have already obtained your
approval to begin work due to the emergency repair needs. Further, Marla Chambers (WRC) stated that no
trout moratorium would be required. The sheam is a UT to the Little Yadkin, Class WSN. We are
replacing a single 36" pipe with 2, 54" pipes of equal length. Flow will be isolated into one barrel, with
floodplain benches constructed at the inlet and outlet. The low flow barrel will be buried 1' below the
stream bed to ensure aquatic passage. There will be no impacts to the jurisdictiona] side channel on the
downstream side of the road.
If you have any questions, comments or need additional information after reviewing this material please
contact me at [phone]. Thank you for your cooperation in this matter.
Respectfully,
��
Amy Eu19ss
Division Environmental Officer
Enclosures
CC: Amy Chapmaq NCDENR-DWR, Trausportation Permitting Unit Supervisor- e-copy
Sue Homewood, NCDENR-DWR, Environmental Specialist- e-copy
Pat Ivey, P.E., Division Engineer, e-copy
Chuck White, P.E., Division Bridge Maintenance Engineer- e-copy
Kiera Keen, Division 9 Roadside Environmental Technician- e-copy
Marla Chambers, WRC- e-copy
Division of Highways • Division Nine • 375 Si1as Creek Pazkway, Winston-Sa]em, NC 27127
Telephone [phone] • Fa7c [phone] • Courier Box 13-12-04

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Corps action ID no.
DWQ project na.
Form Version 1.4 January 2009
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the Corps: ❑X Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps? �X Yes ❑ No
1 d. Type(s) of approval sought from the DWG1 (check all that apply):
�X 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 For the record only for DWQ For the record only for Corps Permit:
because written approval is not required? 401 Certification:
� Yes ❑ No ❑ Yes �X 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 ❑ Yes 0 No
or in-lieu fee program.
1 g. Is the projed located in any of NC's twenty coastal counties. If yes, answer 1 h � Yes ❑X No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes �X No
2. Prqect Infortnation
2a. Name of project: Pratt Road Culvert Replacement
2b. County: Stokes
2c. Nearest municipality / town: Pinnacle
2d. Subdivision name: NA
2e. NCDOT only, T.I.P. or state project no: 9B.20851'I
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT Division 9
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address: 375 Silas Creek Parkway
3e. City, state, zip: Winston Salem, NC 27127
3f. Telephone no.: 336-747-7800
3g. Fax no.: 336-703-6693
3h. Email address:
Page 1 of 10
PCN Form — Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is: ❑ Agent ❑X Other, specify: DEO
4b. Name: Amy Euliss
4c. Business name NCDOT Division 9
(if applicable):
4d. Street address: 375 Silas Creek Parkway
4e. Ciry, state, zip: Winston Salem, NC 27127
4f. Telephone no.: 336-747-7802
4g. Fax no.:
4h. Email address: [e-mail]
5. AgenVConsultant Information (if applicable)
5a. Name:
Sb. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identifcation no. (tax PIN or parcel ID):
1 b. Site coordinates (in decimal degrees): Latitude: 36.28� Longitude: -80.443
1c. Propertysize: L � acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: UT to Little Yadkin River
2b. Water Quality Classification of nearest receiving water: WSIV
2c. River basin: Yadkin
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:
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: 200
3d. Explain the purpose of the proposed project:
replace an existing pipe and collapsing road shoulder on Pratt Road (SR 1144) in Stokes County
3e. Describe the overall project in detail, including the type of equipment to be used:
Remove existing pavement and pipe. Pump around during pipe replacement. Standard road building equipment including a back hoe will be useds
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the � Yes ❑X No ❑ Unknown
Corps or State been requested or obtained for this property /
ro'ect includin all rior hases in the ast? Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made? ❑ Preliminary ❑ Final
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.
5. Project History
Sa. Have permits or certifications been requested or obtained for �Yes ❑X No ❑ Unknown
this project (including all prior phases) i� the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ❑ Yes ❑X No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ❑X 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 impact Type ofwetland Forested Type ofjurisdiction Area of
number Corps (404,10) or impact
Permanent (P) or DWQ (401, other) (acres)
Tem ora T
W1 - Choose ane Choose one Yes/No -
�/�/2 - Choose one Choose one Yes/No -
�/y3 - Choose one Choose ane Yes/NO -
Wq - Choose one Choose one Yes/NO -
1�/5 - Choose one Choose one Yes/No -
�/�/g - Choose one Choose one Yes/NO -
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. 3 d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial (PER) or Type of Average Impact
number intermittent (IN�? jurisdiction stream length
Permanent (P) or width (linear
Temporary (T) (feet) feet)
S1 P Culvert UT to Little Yadkin River PER Corps 5 8
$2 T Dewatering UT to Little Yatlkin River PER Corps 5 30
S3 - Choose one - -
S4 - Choose one - -
SS - Choose one - -
S6 - Choose one - -
3h. Total stream and tributary impacts 38
3i. Comments:
We're replacing a single 36" pipe with 2, 54" pipes of equal length. Flow will be isolated into one barrel, with floodplain benches constructed at the inlet
and outlet. The low flow barrel will be buried 1' below the stream bed to ensure aquatic passage. There will be no impacts to the jurisdictional side
channel on the downstream side of the road. The channel will be dewalered during in stream work.
Page 4 of 10
PCN Form—Version 1.4 January 2009

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 individuall list all o en water im acts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number (if applicable) Type of impact Waterbody Area of impact (acres)
Permanent(P)or type
Tem ora T
01 - Choose one Choose
02 - Choose one Chaase
03 - Choase one Choose
p4 - Choose one Choose
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
5a. Sb. 5c. Sd. 5e.
Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond (acres)
Flooded Filled Excavated Flooded Filled Excavated
P1 Choose one
p2 Choose one
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required? ❑ Yes ❑ No If yes, permit ID no:
Si. 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 an im acts re uire miti ation, then ou MUST f II out Section D of this form.
6a. Project is in which protected basin? ❑ Neuse � Tar-Pamlico ❑ Catawba � Randleman ❑ Other:
6b. 6c. 6d. 6e. 6f. 6g.
Buffer Impact Reason for impact Stream name Buffer Zone 1 Zone 2
number— mitigation impact impact
Permanent (P) or required? (square (square
Tem ora T feet feet
B1 - Yes/No
82 - Yes/No
63 - Yes/No
B4 - Yes/No
BS - Yes/No
B6 - Yes/No
6h. Total Buffer Impacts:
6i. Comments:
Nage 5 o11U

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifcally describe measures taken to avoid or minimize the proposed impacts in designing project.
Pipe length is the minimum necessary to ensure safe passage on the road. The crossing was designed to provide aquatic passage and prevent
stream overvvidening through the use of 2 culverts, with low flow isolated to one barrel, antl installation of Flootlplain henches.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The stream will be dewatered during construction, and sediment and erosion control will be tlesigned according to NCDOT's BMP manual.
2. Com ensato Miti ation for Im acts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ❑ Yes ❑X 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. Com lete if Usin a Miti ation Bank
3a. Name of Mitigation Bank:
Type: Choose one Quantity:
3b. Credits Purchased (attach receipt and letter) Type: Choose one Quantity:
Type: Choose one Quantity:
3c. Comments:
4. Com lete if Makin a Pa ment to In-lieu Fee Pro ram
4a. Approval letter from in-lieu fee program is attached. ❑ Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: Choose one
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Pertnittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form—Version 1.4 January2009

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 ❑X 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.
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. Tatal buffer mitigation required:
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:
Page 7 of 10

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 �X No
within one of the NC Ri arian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes � No
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project? 7� o�o
2b. Does this ro ect re uire a Stormwater Mana ement Plan? ❑ Yes ❑x No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
There was no increase in impervious surface as a result of the projeci. The pavemenf width will remain 24".
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
NA
2e. Who will be responsible for the review of the Stormwater Management Plan? NA
3. Certified Local Government Stormwater Review
3a. In which local overnment's'urisdiction is this ro'ect? NA
❑ Phase II
3b. Which of the following locally-implemented stormwater management programs ❑ NSW
apply (check all that apply): ❑ USMP
� Water Supply Watershed
� Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ❑Yes ❑ No
attached?
4. DWQ Stormwater Pro ram Review
�Coastal counties
❑HQW
4a. Which of the following state-implemented stormwater management programs apply �ORW
(check all that apply): ❑Session Law 2006-246
❑Other:
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
5b. Have all of the 401 Unit submittal requirements been met? ❑ Yes � No
Page 8 of 10
PCN Form — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. 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 ❑X No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been fnalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA fnal approval
letter.) minimum criteria documentation is available upon request ❑ 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 ❑X No
or Riparian Buffer Rules (15A NCAC 26 .0200)?
2b. Is this an after-the-fact permit application? ❑Yes �X 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 �X 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
NA the proposed project, or available capacity of the subject facility.
Page 9 of 10
PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. W II this project occur in or near an area with federally protected species or � Yes �X No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act � yes ❑X No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted. -
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC Historic Preservation Office GIS viewer and feld verifcation
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes ❑X No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
7. Historic or Prehistoric Culturel 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 ❑X 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?
feld determination
8. Flood Zone Designation (COrps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ❑ Yes �X No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
, �m ��u l� ss / � ` f � 1 ``f
A�icanUAgenYs Printed Name pph ant/AgenYs Signature Date
(Agent's signature is valid only if an authorization
letter from the a licant is rovided.
Page 10 of 10

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