20140273 Ver 1_Application_20140321

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STATE OF NORTH CAROLINAo�
DEPARTMENT OF TRANSPORTATION
PAT MCCRORY ANTHONY J. TATA
GOVERNOR SECRETARY
March 19, 2014
r
Mr. Thomas Steffens
U.S. Army Corps of Engineers
Washington Regulatory Field Office 2 ?
2407 W 5`'' St. 4
Washington, NC 27889
Mr. Robert Ridings
DWQ- Transportation Permitting Unit
1650 Mail Service Center
Raleigh, NC 27609
U ');ID31
Subject: TIP: U -4$$9 Widening of SR1616 (Country Club Road) from US64 business
(Buck Leonard Blvd. to SR1541 (Jeffreys Rd.) in Nash County
WBS # 34927.1.1
Dear Sirs:
The North Carolina Department of Transportation ( NCDOT) proposes to widen SRI 616
(Country Club Road) from US64 business (Buck Leonard Blvd. to SRI 541 (Jeffreys Rd.) in
Nash County from a two lane section to a four lane divided section with curb and gutter. The
main purpose of this project is to improve the level of service (traffic flow) for SR 1616
(Country Club Road).
Impacts to jurisdictional areas will occur at several locations, the primary site being the
bridge over Stoney Creek. This structure will be completely demolished and replaced
with a much wider, and longer structure. Impacts will include 24 new drill piers in this
stream as well utilization of a temporary causeway in order to construct these new bents.
Other impacts are associated with pipe extensions and stream improvements /stabilization.
NCDOT anticipates that this project will be authorized under a NWP 13 and 14. This
application is also intended as a request for written authorization from the NC Division of
Water Quality to proceed under General Water Quality Certificates 3885 and 2886 as well as
Tar River buffer rules.
(252) 237 -6164 x 3532 ccoggins @ncdot.gov
Post Office Box 3165, Wilson, North Carolina 27895 -3165

For our files, please provide written notice that this activity is authorized. If you have any
questions or need additional information, please contact Chad Coggins, Division Environmental
Officer at (252) 296 -3532. Your time and assistance are greatly appreciated.
Respectfully Submitted,
T.M. Little, PE
Division Engineer
(252) 237 -6164 x 3532 ccoggins @ncdot.gov
Post Office Box 3165, Wilson, North Carolina 27895 -3165

�2 ,�
fl �
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 El Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 13,14, 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
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below.
❑ Yes
® No
1 h. Is the project located withirr a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2. Project Information
2a. Name of project:
Widening of SR1616 (Country Club Road) from US64 business (Buck Leonard Blvd. to
SR1541 (Jeffreys Rd.)
2b. County:
Nash
2c. Nearest municipality / town:
Rocky Mount
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project 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 1 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:
Tim Little PE Division Engineer
4c. Business name
(if applicable):
NCDOT Div. of Highways
4d. Street address:
PO Box 3165
4e. City, state, zip:
Wilson, NC 27895 -3165
4f. Telephone no..
252- 237 - 6164x3501
4g. Fax no.:
252 - 234 -6174
4h. Email address:
tmlittle(a)ncdot.gov
5. Agent/Consultant Information (if applicable)
5a. Name:
Chad Coggins -
5b. Business name
(if applicable)
NCDOT Div. 4 Environmental Officer
5c. Street address:
same
5d. City, state, zip:
same
5e. Telephone no.:
252 - 296 -3532
5f. Fax no.:
252 -234 6174
5g. Email address.
[e-mail]
Page 2 of 12

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
1 b. Site coordinates (in decimal degrees):
Latitude: 35.96680 Longitude: - 77.8264
(DD DDDDDD) (- DD.DDDDDD)
1 c. Property size:
acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Stoney Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
C, NSW 303D
2c. River basin:
Tar
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:
Heavy Commercial and Urban
3b. List the total estimated acreage of all existing wetlands on the property:
0.10 ac.
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
500 LF
3d. Explain the purpose of the proposed project:
The purpose of this project is to improve the level of service (traffic flow) for SR 1616 (Country Club
Road)
3e. Describe the overall project in detail, including the type of equipment to be used:
Widening- SR 1616 (Country Club Road) from a two lane to a four lane median divided facility with curb
and gutt0r Typical heavy construction roadway and bridge equipment will 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.
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:
Name (if known): NCDOT div. 4 staff delineated jurisdictional
Other:
features
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for
❑ Yes ❑ 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 3 of 12
PCN Form —Version 1.3 December 10, 2008 Version

Page 4 of 12

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
Site 1 ® P ❑ T
MC
BHW
® Yes
❑ No
® Corps
❑ DWQ
.01
Site 2 ® P ❑ T
MC
BHW
®'Yes
® Corps
❑ No
❑ DWQ
.01
Site 2 E] P ®T
Temp fill for
F
BHW
® Yes
® Corps
01
causeway
El No
El DWQ
Site3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
Site 3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
Site 3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
0.03
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 jurisdiction
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)
Site 2 ® P ❑ T
New Bents 24 - -3'
diameter shafts
Stoney Creek
® PER
❑ INT
® Corps
❑ DWQ
25
170 SF
Site 2 ® P ❑ T
Bank Stabilization
Stoney Creek
® PER
❑ INT
® Corps
❑ DWQ
25
130 LF
Site 2 ❑ PET
Temporary stream
impacts to make
Stoney Creek
® PER
® Corps
25
19 LF
bank stabilization
❑ INT
❑ DWQ
tie in
Site 2 [] P ®T
Temporary fill for
Stoney Creek
® PER
❑ INT
❑ Corps
❑ DWQ
25
0.09 AC
causeway
Site 3 ® P ❑ T
Bank Stabilization
UT to Stoney
® PER
® Corps
❑ DWQ
4
34 LF
and ditch tie in
Creek
[J INT
Temporary stream
UT to Stoney
® PER
® Corps
4
24 LF
Site 3 ❑ POT
impacts to make
Creek
❑ INT
E] DWQ
ditch tie in
Page 5 of 12

Site 4 ®P El T
Pipe extension
UT to Stoney
® PER
® Corps
8
36 LF
Creek
❑ INT
❑ DWQ
Bank Stabilization
Site 4 ® P ❑ T
channel
UT to Stoney
® PER
® Corps
8
100 LF
improvements and
Creek
❑ INT
❑ DWQ
dewatering
Site 5 ® P ❑ T
Bank stabilization
UT to Long
❑ PER
® Corps
2
40 LF
and ditch tie in
Branch
® INT
❑ DWQ
Site 5 ❑ P ® T
Temporary stream
impacts to make
UT to Long
❑ PER
® Corps
2
24 LF
ditch tie in
Branch
®INT
❑DWQ
3h. Total stream and tributary impacts
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 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
01 ❑P ❑T
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
0. 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)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
number
of pond
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:
Page 6 of 12

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
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
' impact
Stream name
mitigation
(square feet)
(square feet)
Temporary T
required?
Site 2 ® P ❑ T
Bridge and
utility work
Stoney Creek
❑ Yes
® No
9215
6057
Site 3 ® P ❑ T
Excavation
and access
UT to Stoney Creek
El Yes
3670
1317
Site 4 ® P ❑ T
Fill and
UT to Stoney Creek
El Yes
®
7535
5020
access
No
6h. Total buffer impacts
20420
12394
6i. Comments:
Page 7 of 12

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
We propose making the proposed improvements within the footprint, or immediately adjacent to the footprint, of the
existing transportation structure, thereby avoiding impacts associated with making such improvements on a new
alignment.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
All construction equipment will be staged and operated from the existing roadway and associated uplands. DOT will also
install silt fencing to protect the stream and wetlands adjacent to this project, and safety fencing to delineate those
environmentally sensitive areas. The temporary rock causeway will be made of non - erodable stone placed on fabric and
will be removed completely and restored to preexisting conditions upon completion of bridge work. The NCDOT BMP
manual will be strictly adhered to throughout the construction of this project.
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
-
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
El 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 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
4c. If using stream mitigation, stream temperature:
❑ warm ❑ cool [-]cold
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 Permittee 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 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
21
3 (2 for Catawba)
Zone 2
1360
1.5
6f. Total 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 9 of 12

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a. 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 no, explain why.
®Yes El No
Comments: -see attached SMP
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
N/A
2b. IDoes 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 SMP
❑ 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?
N/A
❑ Phase II
❑ NSW
3b. Which of the following locally - implemented stormwater management programs
❑ USMP
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
❑ 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 El 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 10 of 12
PCN Form — Version 1.3 December 10, 2008 Version

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 ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. 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 ❑ 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 ❑ 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.
EA and corresponding FONSI approved
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. No sewage will be generated as a result of this project.
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 ® 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?
completed mussel survey and USFWS concurrence
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?
AFSA GIS layer and upstream of dam
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?
Clearance from NC SHPO ` '
8. 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: No Net Rise MOA been reviewed and approved by NCDOT
Hydraulics Unit
8c. What source(s) did you use to make the floodplain determination? NC flood Map
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)
Page 12 of 12

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TOB EL. =�SOUTHJ 89.0'
NORTH 88.0'
PROP. RIP RAP--"'
BANK STABILIZATION
SECTION A -A
161.5' (TO CL END BENT 1)
61.5' (TO � END BENT 2)
CLASS A RIP RAP
FILTER FABRIC
CLASS II RIP RAP
SECTION B-B
NWS EL. = 83.8'
----- - - - - --
CHANNEL BOTTOM
EL= 79.6'