20140222 Ver 1_Application_20140307

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STATE (�►F N(JRTH CAROLINA
DEPARTMEIr1T (JF TRANSPC}RTATION
PAT Mc�RORY� P. (J. Box 25201, Raleigh, NC 27611-5202 ANT�-I�NY J. TATA
C,.�rOVERNOR PHONE: [phone] SECRETARY
March 7, 2n 14
1�/Ir, Andy Williams
tT. S. Ar�ny Corps of Engineers
Raleigh Regulatary Field t�f� ce
3 3 31 Herit�ge Trade Drive, Suite 1 QS
VVa�e Forest, NC 2� 5 87
Subj ect: Nationwide Permit #3
Repair Scour on Culvert #85-2088 �n NC 103 east of 1VIt. A1ry
Surry County, North Carolina
Project Number: 118.108+611 (No D'�Q Permit Fee Required)
Dear ��Ir. Williams:
The Narth Carolina Department af Transpartation has completed r�pairs tc� address ��our and to
elevate the outlet end wall of Culvert #$5-2088 on NC 1 Q3 east of Mt. Airy. The existing RCBC
is perched with a plunge pool at the outlet, Scour had undermined the culvert outlet and vving
walls. We dewatered the construction area and filled the plun:ge pool and lined the banks �vlth
riprap to stop the scour issue. Plunge poal riprap is a znlxture of class II and class B stone. This
heterc�geneous mixture was tapered dawn from the lip of the culvert outlet to the end of the pool.
I will attach before, during and a�ter phatos. Stream impacts are tabulated below:
Stream Impacts:
Station Existing Proposed "Temporary Riprap Total Impacts at
Number Structure Structure I)ewatering Irnpacts this Station (ft.)
Size feet
No Change to
Culvert RCBC Structure 10' outlet 20 3�
#85-2058 Len th
Permanent FillJRiprap Impacts = 20 f�et 'I'otal Project Impacts = 30
feet
P. +Q. Box 250, N. V�ILxESBO�zo, NC 28659
P�-�or�E [phone] FAx [phone]
,

Mr. Andy Williams
Culvert #85-2488 on NC 103, Surr�
Fage 2
March 7, 2014
The proj ect required temporary devvatering. An impervious plyvvaod and sandbag dil�e was
constructed ins�de of t�e culvert with a jump pipe in the dik�. Clean water was temporarily
piped through the construction area and discharged downstream. The impervlous dike vc�as
removed after all of the repairs were complete.
Construction of this proj ect required impacts ta wa�ers of the tJnited States in the Roanoke River
Basin. The existing culvert carries a LTT ta Silverl�af Creek (C1ass: C; Trout). This project �vas
reviewed for the presence of thr�atened and endangered species. The subj ect proj ect �will have
na effect on any federall� listed endangered plant or anirnal species, T�'l15 �.Ct1Vlt� 1S �X�'171pt
fr4111 illStOrlCa� r�V1�W.
The project impacts are not significant in nature and should not alter the best usage for thls
stream. All appropriate BMPs were used during cc�nstruction. Attached is an af�er-the-fact
Preconstruction Noti�catior� �'or�n, a marked county map, a marked topography rnap and photos.
By copy of this letter, it is requested that Mrs. Marla Chambers with the North Carolina Wildlife
Resaurces C01111111SS1011 comment directly ta you concerning the 404 Nationwld� Per�nit
application with a copy sent to me.
We appreciate yau allowing us ta complete this emerg�ncy repair quickl�. If further infor��nation
is required, please let me know.
Sincerely,
�
�.
��
��e ath S 1 aughter
D�ivision E�virnnmental Of�cer
Enclosures
cc: Marla Chambers, Western Piedmont Region �oordinator, NCWRC
Amy Chapman, Division of Water Quality
David Wayne, PE, Division Bridge Maintenance Engineer
Chase Threlkeld, Roadside Environmental Field C�perations Techniclan
,

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����� `�.'����� ���� Farm Versian 1.3 aec 14 2a08
�«,. �
Pre-Construction Notification (Pt�N� Form
A. A�a�alic�nt Infarmation
1. Processing
1 a. Type(s) of approval sought fram the
Cc�r s: ��ection 4U4 Permit ❑ Section 10 Permit
p
1 b. Specify Nationwide Permit (NWP) number: 3 or Gener�l Permit {GP) number:
1 c. Has the NWP or GP number been verified by the Corps? ❑ Y�s
1 d. Type(s) of approval saught from the DWQ (check all that apply):
� 4a1 Water Quaiity Certificatior� -- Regular ❑ Non-4�4 Jurisdictional General Permit
❑ 401 Water Quality Certificatinn -- Express 0 Riparian Buffer Authori�ation
1 e. Is this notificatian soiely for the record For the record only f�r DWQ 401
because written approval is not required? Certification:
� Yes 0 No
1 f. Is payment into a mitigation bank ar in-lieu fee pragram proposed for mitigation
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
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC}?
2. Project Information
►1 •
For the record only for Corps Permit:
0 Yes � No
❑ Yes � No
❑ Yes � No
❑ Yes � No
2a. Name of project: Repair Culvert #85-2088 on NC 103 east of Mt. Airy
2b. County: Surry
2c. Nearest municipality I town. Mt. Airy
2d. Subdivision name:
2e. NGDOT anly, T. I. P. ar state 11 B.108611
project n+�:
3. Owner Infarmation
3a. Name(s} on Recorded Deed: NCDOT
3b. Deed Book and Page Na.
3c. Responsibi� Party (for LLC if
applicable):
3d. Street address: 841 Statesville Road
3e. City, state, zip: North Wilkesboro, NG 28659
3f. Telephone no.: 336-903-9202
3g. Fax na.: 336-667-4549
3h. Email address: hslaughter�C�ncdat.gav
Page 1 of 10
PGN F�rm — V�rsion 1.3 Decernber '14, 20�8 Version
,

4. Applicant Information (if different from owner)
4a. App{icant is: ❑ Agent C] Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. �treet address:
4e. City, sfiate, zip:
4f. Telephone no.:
4g . Fax no. :
4h. Email address:
5. Agent/Cc�nsultant Inforrnation {if applicable)
5a. Name:
5b. Bu�iness name
(if appiicable):
5c. Street add ress:
5d . C ity, state, zi p:
5e. Telephone no.:
5f. Fax na.:
5g. Email addre�s:
Page 2 of 1a
PCN F�rm -- Versian 1.3 December 14, ZOnB Version
,

B. Project Information and Prior Project History
1. Property Identification
1a. Properky identification na. (tax PIN or parcel ID�:
1b. �ite coordinates (in decimal degrees):
L�titude. 36.55037 Longitude. - 80.48639
(DD.DDDDDD) {-DD.DDDDIJD)
1 c. Property size: 0.1 acres
2. Surface Waters
2a. Name af nearest body of water (stream, river, etc.) to UT tQ Silverleaf Creek
proposed praject:
2b. Water Quality Classification of nearest receiving water: C; Trout
2c. River basin: R�anoke
3. Project Description
3a. Describe the existing conditions on the site and the generai land use in the vicinity ofi the project at the fiime of this
application:
Undermined culvert in a rural area
3b. List the total estimated acreage of all existing wetlands on the praperty:
� acres
3c. List the totai estimated linear feet of all existing streams (intermittent and perennial) on the property:
60 feet
3d. Expiain the purpose of the proposed project:
Repair culvert
3e. Describe fihe overall praject in detail, including the type of equipm�nt to be used:
See attached cover Ietter.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for �his property /
project (including all prior phases) in �he past? ❑ Yes � No 0 Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made? (� Preliminary ❑ Finaf
4c. If yes, who delineated the jurisdictional areas? AgencylConsu(tant Company:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdicfiional determinations or State determinations and attach documentation.
5. Project History
5a. Haue permits or certifications been requested ar abtained for ❑ yes
this project (including ali prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
�a. Is this a ph�sed praject?
6b. If yes, explain.
❑ Yes
►1 •
�/ i
■ •
Page 3 of 1 a
PCN F�rm — Versian 1.3 December 10, 2008 V�rsic�n
,

C. Proposed i mpacts 1 nventory
1. Impacts Summary '
1 a. Which sections were completed below for your project (check ail that apply}:
Cj Wetlands � Streams - tributaries �] Bu�fer�
�] (�pen Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts praposed on fhe site, then complete this question for each wetland area impacted.
2a. 2b. Zc. 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-4Q4, other} (acres)
Tem ora T
❑ Yes �J Corps
W1 ❑P❑T ..
W2 CJP❑T
■ w ■
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� r �
❑ N�
❑ Yes
❑ N c�
C� Yes
� N c�
� Yes
❑ No
C] Y�s
❑ N�
❑ Y�s
W6 ❑ P 0 T Nca DWQ
❑ ❑
Zg. Total wetland impacts
2n. Comments:
3. Stream Impacts
If there are perennial or intermifiten� stream impacts {including tempor�ry impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c, �d. 3e. 3f. 3g.
Stream impact Type of impact Stream name �°erennial Type of jurisdictian Average Impact
number - (PER) or (Corps - 404, 10 stream Iength
Permanent (P) or intermittent p�/(� — non-404, width (line�r
Temporary (T} (I f�T)? other} (feet} feet)
Riprap & UT to Silverleaf � PER � Carps
S1 � P� T Dewaterin Creek INT DV1IQ �� 30
g ❑ �
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S3 ❑P❑T
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. � . �
S6 C]PC]T
3h. Total stream and tributary impacts
3i. Comments: 2Q Riprap, 10 Dewatering
■�
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■' '
■
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■
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❑ Corps
C] DWQ
❑ Corps
❑ DWQ
❑ Corps
❑ DWQ
0 Corps
� DWQ
D Corps
❑ D�NQ
Page 4 of 10
PCN F�rm — Version 1.3 [�ecember 1 U, 2008 Version

4. Qpen Water Impacts
If there are propased impacts to lakes, pands, estuaries, tributaries, s�aunds, the Atlantic C�cean, c�r any other open water of
the U.S. then individuaily list all apen water impacts below.
4a. 4b. 4c. 4d. 4e.
4pen water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type ,�rea of impact (acres)
Permanent (P) or
Tem orar T
CJ1 ❑P❑T
02 []P❑T
03 ❑P�T
04 [� P [� T
4f. Total open water impacts
4g. Comments:
5. Pond or �ake Constructian
If ond or lake cc�ns�ruction ro osed, then com lete the chart beiow.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpase (acr�s)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Tota1 '
5g. Comments: NlA
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. Methad of construction:
6. Buffer Impacts (far 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 require miti atian, then ou MUST fil! out �ectian D af this form.
6a. Neuse T r-P mli
� ❑ a a co ❑ Other.
Project is in which protected basin? ❑ Catawba j� Randfeman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number -- Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitig�tion (square feet} (square feet)
Tem orar T im act re uired?
C� Y�s
B1 �P❑T Nc�
[� c�
Q Yes
B2 ❑ P ❑ T ��
❑
[� Yes
B3 ❑P❑T No
❑
6h. Total buffer impacts ;
6i. Comments:
Page 5 af 14
F'CN F�rm -- Versic�n 1.3 December 1�, 20�8 Version
,

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specificaily describe measures taken to avoid or minimize th� proposed impacts in designing praject.
Riprap was limited to 20 feet
1 b. Specificaliy describe measures taken to avoid or minimize the proposed impacts through construc�ion techniques.
All apprapriate BMPs were be used during construction
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Gompensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply):
2c. If yes, which mitigatian aptian will be used for this
project?
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purcnased (attach receipt and letter)
3c. Comments:
■ -� �1 •
[� DWQ ❑ Corps
❑ Mitigation bank
❑ Payment to in-lieu fee prngram
❑ Permittee Responsible Mitigation
T�pe ' Quantity
4. Complete if Making a Payrnent ta In-lieu Fee Pragram
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 C] cool ❑cald
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wefiland mitigation requested: acres
4f. Non-riparian wetland mitigatian requested: acres
4g. Coastal {tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Ptan
5a. If using a permittee responsible mitigation plan, pravide a description of the proposed mitigation plan.
Page 6 0� 1�
PCN Fc�rm -- Version 1.3 Decembe� �0, ZOU8 Version
,

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) -- rec�uired by DWQ
6a. Wili the praject result in an impact within a protected riparian buffer that requires Cj Yes � No
buffer mitigatian?
6b. If yes, then identify the square feet of impact ta each zone of the riparian buffer that requir�s mitig,�tic�n. Calculate the'
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact iVlultiplier Required mitigation
(square feet) (square feet}
Zone 1 3(2 fc�r Catawba)
Zone 2 1.5
6f. Tatat buffer mitigation required:
6g. If buffer mitigation is required, discuss what type af mitigatian is proposed (e.g., payment ta priv�te mitigation bank,
permittee responsible riparian buffer restoration, payment into an �ppraved in-lieu fee fund).
6h. Comm�nts:
Page ? ofi 10
PCN Fc�rm -- Version 'I .3 CJecember 10, �008 Versir�n
,

E. Starmwater Management and Diffuse Flow Plan {required by DWQ)
1. Diffuse Flow Pian
1a. Does the project include �r is it adjacent to protected riparian buffers identified
within one of the NC Riparian Buffer Protection Rufes?
1 b. If yes, then is a diffuse flow plan included? lf no, expfain why.
Comments:
[� i�es � No
0 Yes 0 No
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project? °10
2b. Does this project require a Stormwater Management Plan? ❑ Yes � No
2c. If this project D4ES NO►T require a Stormwater Management Plan, explain why: Disturbing � 1 acre
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
❑ Gertified Local G�vernment
2e. Who will be respansible for the review of the Stormwater Management Plan? ❑ DWQ Stormwater Program
❑ DWQ 401 U n it
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
3b. Which of the following locally-implemented stormwater management programs
apply (check all that apply}:
3c. Has the approved Stormwater Management Plan with proof of approval been
attached?
4. DWQ Stormwater Proqram Review
� Phase II
[� N SW
❑ USMP
❑ Water Supply Watershed
� Other:
❑ Yes ❑ No
❑ Coastal countie� '
❑ HQW
4a, Which of the following state-implemented stormwater management programs apply � pR�
(check all that apply):
❑ Session Law 2C;06-246
❑ 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?
5b. Have all of the 401 Unit submittal requirements been met?
[� Yes ❑ No
❑ Yes C] No
Page 8 ofi 1 �
PCN F�rm -- Versian 1.3 December 'I O, 20U8 Version
,

F. Suppiementary Infarmation
1. Enviranmental Documentation (DWQ Requirementj
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the Yes N
use of ublic feder�llstate land? � �°
� � )
1 b. If you answered "yes" to the above, does the project require prep�ratian of an
environmental document pursuant to the requirements of the Nati�nal or State ❑ Yes �j iVo
(North Carolina) Environrnental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing Hause? (If sa, attach a copy of the NEPA or SEP� finai approual
leiter.} ❑ Yes � No
Comments.
2. Violations (DWQ Requirement)
2a. is the site in violation of DWQ Wetland Rules (15A NCAC 2H .a500), Isolated
Wetland Rules {15A NCAC 2H .13�0), DWQ Surface Water or iNetiand �tandards, ❑ Yes � No
ar Riparian Buffer Rules (15A NCAC 2B .�200)?
2b. Is this an after-the-fact permit appiication? � Yes [� No
2c. If you answered "yes" to ane or both of the above questions, provide an explanation of the violation{s): Emergency Repair
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
additional develo ment, which could im act nearb downstream water ua{it ? ❑ Yes � No
p P Y q Y
3b. If you answered "yes" to the above, submit a qualitative or quantit�tive cumulative impact analysis in accordance with the
most recent DWQ palicy. If you answered "no," provide a short narrative description.
4. Sewage Dispasal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated frc�m
the prapased praject, or available capacity of the subject facility.
N/A
Page 9 �f 14
PCN F�rm -- Version 1.3 December 10, 2�48 Version
. �

5. Endangered Species and Designated Critical Habitat �Carps t�equirement)
5a. Will this praject occur in or near an area with federally protected species or
habitat?
5b. Have you checked with the USFV1/S concerning Endangered Spe�ies Act
impacts?
5c. If yes, indicate the USFWS Field Office yau have contacted.
❑ Yes �j No
❑ Yes � No
❑ R�leigh
�] Asheville
5d. What data sources did you use to determine whether your site wouid impact Endangered �pecies or Designated Criticai
Habitat?
G1S and visual observatian
6. Essential Fish Habitat (Corps Requirement)
6a. Vllill this project occur in or near an area designated as essential fish habitat? (❑ Yes
6b. What data sources did you use to determine whether your site wauld impact Essential Fish Habitat?
WRC will comment
I�1 •
7. Historic or Prehistoric Cultural Resaurces (Corps Requir�me�t)
7a. Wiil this project occur in ar near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation Yes No
status e. ., National Historic Trust desi nation or ro erties si nificant in � �
C 9 9 P p 9
North �arolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impac� historic or archeological resources'?
Exempt
8. Flood Zane Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 1 a0-year floodpl�in? ❑ Yes ❑ No
8b. If yes, explain how project meets FEMA requirements: Not changing structure size or BFEs.
8c. What source(s) did you use to make the floodplain determination? ncffoodmaps but web site down
J. I�eath Slaughter
Applicant/Agent's Printed Name
�
Applicant/Agent's Sig ture
(Agent's si ature is valid only if an authoriza ' n ietter from the applicant
is provided.)
3/7/ 14
Date
Page 10 of 1� '
PCN Form -- Version 1.3 December � 0, 20n8 Version
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WebForm 1
County: Surry Number: 852088
Route Carried: NC703 Across: CREEK
Location: 0.1 MI. W. JCT. SR7792
Milepolnt: 0 Ciry:
Lattilutle:363236.1 Longitude:902928.4
Inspected By: TDH Inspection Date: 41912009
P. A. Issued: N Remaining Lite: 20
Description of Signs: NONE
Year Built: 0 NC Skew: 90
7ype And Material: 7@ Bx8 RCBC
Grade: 1 Coating: NONE
Brl Hght: 6 Brl Wdth: 6
Num of B�Is: 1 Water Depth: 0.08
Culvert 7ype: RCBC Length Along CulveA: 45
Approach Shoulders: Lek:4
Headwalis: Inlet:CONCRETE
Work Codes:
No Work Codes were found for this Structure
General Comments:
None
Page 1 of 1
Map Key:
Total Field Time: {0}
System: SECONDARY
StrucWreConditlon: FAIR
Sign Notice Issued: N
Dist Between Brls: 0
Hght Crown to Bed: 74
Lenglh Along Roadway: 8
Approach Roadway Width: 0
Righl: 4
Outlet: CONCRETE
https://apps.dot.ncnet/Bridge/SmallPipe/DisplayStructure.aspx 1 /27/2014

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