20140348 Ver 1_Application_20140409

PAT MCCRORY
GOVti2NOR
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STATE OF NORTH CAROLINA
DEPARTMENT OF T'RANSPORTATION
Apri17, 2014
SUBJECT: Stokes County — SR 1463 pipe replacement
WBS project no.: 9B208511
Mr. John Thomas
US Army Corps of Engineers
3331 HeriTage Trade Dr.
Suite 105
Wake Forest, NC 27615
Deaz Mr. Thomas,
ANTHONY J. TATA
SECRETARY
We aze requesting a Nationwide 3 permit for a pipe replacement on Sanders Shelton Road (SR 1463) in
Stokes County. I have attached a pre-construction notification application with supporting documentation.
The stream is a UT to the Dan River, Class C; Tr. We are replacing a single 3S X 36" pipe with 2, 40' X
60" pipes. Low will be isolated 'mto one barrel, with floodplain benches conslructed at the inlet and outlet.
The existing pipe is perched. The new low flow pipe will not be perched The low flow barrel will be
buried 1' below the stream bed to ensure aquatic passage. Work will occur as soon as pertnits are received,
and no work will occur during the trout moratorium if required. By copy of this letter, we request that Mrs.
Mazla Chambers, NCWRC, provide comments regazding the project.
The project is within 1 mile of a known population of James Spiny Mussel on the Dan River. We also
request that Mr. Jason Mays of the USFWS concur with the May Affect not Likely to Adversely Affect
call. Despite the close proximity to a Imowqpopulation on the Dan River, the u�named hibutary is small
(<2° Wide) and is heavily impacted by sediment and livestock.
If you have any questions, comments or need additional information after reviewing this material please
contact me at [phone]. Thank you for your cooperation i� this matter.
Sincerely,
�
Amy Euliss
Division Environmental Officer
Enclosures
CC: Amy Chapman, NCDENR-DWR, courtesy copy, e-copy
Dave Wanucha, NCDENR-DWft, courtesy copy, 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
Jason Mays, USFWS, e-copy
Division of Highways • Division Nine • 375 Silas Creek Pazkway, Winston-Salem, NC 27127
Telephone [phone] • Fa�c [phone] • Courier Box 13-12-04

oF wnrFq
02 oL Ofice Use Only:
� � � y Corps action ID no.
�,�, i o � DW(1 project no.
Fortn 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: 0 Section 404 Pertnit ❑ 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? � Yes ❑ No
1 d. Type(s) of approval sought from the DWQ (check alI that apply):
� 401 Water Qualily Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certifption — Express ❑ Riparian Buffer AuthorizaGon
1 e. Is this notification solely for the rewrd For ihe record only for DWQ For the rewrd only for Corps Permit:
because written approval fs not required? 401 Certification�
� Yes ❑ No ❑ Yes � No
1f. Is payment into a mitigation bank or in-Ileu 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 project located in any of NC's twenty coasial counties. If yes, answer 1 h
below. ❑ Yes ❑X No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes 0 No
2. Project Infortnation
2a. Name of project: Pipe repiacement on SR 1463
2b. County: Stokes
2c. Nearest municipality / town: Westfield
2d. Subdivision name: NA
2e. NCDOT only, T.I.P. or state project no 1NBS no. 9B208511
3. Owner infortnation
3a. Name(s) on Recorded Deed: NCDOT Division 9
3b. Deed Book and Page No.
3c. Responsible Party (for LLC �f
3d. Street address:
3e. City, state, zip:
3f. Telenhone no.:
3g. Fax no.:
3h. Email address:
375 Silas Creek Parkway
Winston Salem, NC 27127
336-747-7800
336-703-6694
Page � of 10
PCN Form — Version 1.4 January 2009

Page 2 of 10

B. Project Information and Prfor Project History
1. Property Identification
1 a. Property identification no. (tax P1N or parcel ID): NA
1 b. Site coordinates (n decimal degrees): Latitude: 36.51171
1c. Propertysize:
2. Surtace Waters
2a. Name of nearest body of water to proposed project:
2b. Water Quality Classification of nearest receiving water.
2c. River basin:
0.034 acres
UT to Dan River
Class C; Tr
Dan River
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
applicaiion:
Trie sheam is curtently piped under the existirg roatl. The land surtounding the stream Is grezed by livestock.
3b. List the total estimated acreage of all existing wetlands on the property: 0
3c. List the totai estimated linear feet of all existing streams (intermittent and perenniai) on the property: 100
3d. 6cplain the purpose of the proposed project:
Replace a tailing 36" pipe with 2, 60" pipes with flow isolatetl into one barrel which will be 6urietl. The other barrel will function as an overflow bartel.
3e. Describe the overall project in detail, including the type of equipment to be used:
The stream will be tempo2rity dewetered during construction. Slandartl road buliding equipment will be used.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the � Yes � No ❑ Unknown
Corps or State been requested or abtained for this property /
ro'ect includin all rior hases in the ast? Comments:
4b. If the Corps made the jurisdictional delermination, what type prelimina
of determination was made? ❑ �Y ❑ Final
4c. If yes, who delineated the jurisdictional areas7 Agency/Consultant Company:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdiclional determinaGons or Stata determinaGons and attach documentation.
5. Project History
Sa. Have permits or certifications been requested or obtained for
this project {including all prior phases) in the past?
Sb. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased prajec
Bb. Ifyes, explain.
❑ Yes
❑ Yes
O No
No
❑ Unknown
Page 3 of 10
PCN Form —Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were compleied below for your project (check all that apply):
❑ Wetlands OX 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 wetiand area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of impact Type of wetland Forested Type ofjurisdiction Area of
number Corps (404,10) or impact
Permanent (P) or DWQ (401, other) (acres)
Tem ora
W� - Choose one Choose one YasMO -
� - Choose one Choose one YeslNo -
W3 - Choose one Choose one YesrtJO -
W4 _ Choose one Choose one YesMo -
W5 - Choose one Choose one Yes/No -
wg - Choose one Choose one Yes/NO -
2g. Total Wetland Impacts:
2h. Comments:
3. Stream Impacts
If there are perennial or intertnittent stream impacts (Including temporary impads) 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 (PER) or Type of Average Impact
number intermittent (IN�? jurisdiction stream length
Permanent (P) or width (linear
Temporary (� (feet) feet)
S1 P Culvert UTDanWver PER Corps 2 10
$z T Dewater(ng UT Dan River PER Corys 2 25
S3 - Choose one - -
g,q - Choose one - -
SS - Choose one - '
S6 - Chooseone - '
3h. Total stream and tribufary impacts
3i. Comments:
M additional 10' of plpe is necessary to bring road up to safety sta�ards, Low Flow vrill be isolated into on barteL The low flow banel will 6e buried 1'
below the stream bed. The high flow barrel will be Iaid at grade. Floodplain benches will be consWC[etl at ihe inlet and outlet to preveM overvvidemng.
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 individual list all o en water im acts below.
4a. 4b. 4c. qd. qe.
Open water Name of waterbody
impact number (if applicable) Type of impact Waterbody Area of impact (acres)
Permanent (P) or }�,Pe
Tem ora
01 - Choose one Choose
02 - Chaose one Choose
03 - Choose one Choose
04 - Choaseane Choose
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construc6on
If ond or lake construction ro osed then com lete the chart below.
5a. 5b. 5c. 5d. Se.
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. Toial:
Sg. Comments:
Sh. Is a dam high hazard pertntt required? � Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5. 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 ail buffer impacts
6elow. If an im ads re uire mili atlon, then ou MUST fill 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.
Butfer Impact Reason for impact Stream name Buffer Zone 1 Zone 2
number— mitigation impact impact
Permanent (P) or re uired?
Tem ora 4 (square (square
feet feet
8� - vesMo
BZ - Yes/No
B3 - Yes/No
� ' Yes/No
B5 ' Yes/Na
� - Yes/No
Bh. Total Buifer Impacts:
6i. Comments:
� ayc.ivi iu

D. Impact Justrfication and Mitigation
1a. Specifically describe measures taken to avoid or minimize the proposed impads in designing project.
Law flow vr,ll be isoia[etl irrto on barrel. The low fiow bartel will 6e buried 1' below the stream betl. The high flow barrel will he laid at grade. Floodplain
benches will be constructed at the Inlet and oWet to prevent ovelwitlenirg.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construdion techniques.
Best management practices will be utilized during construction to reduce tlie potential for sedimentation. More specifically, the work area will pe
dewatered by pump around. The sVeem will be damnetl oR upstream otihe work area, antl pumped ihrough a grassetl filter before the water
discharges into ihe stream. Waterfrom the work area will be pumped down and adequatey treatetl prior to discharging back Into ihe stream.
2a. Does the projed require Compensatory Mitigatlon for
impacts to Waters of the U.S or Waters of the State?
2b. If yes, mitigation is required by (check all that apply):
n Waters of the State
� Yes OX No
❑ DWQ ❑ Corps
❑ Mi6gation bank
2c. If yes, which mitigation option will be used for this ❑ payment to in-Iieu fee program
ProJe�?
❑ Permittee Responsible Mitigation
3 Complete if Usinq a Mitigation Bank
3a. Name of Mitigation Bank:
Type: Choose one Gluantity:
3b. Credits Purchased (attach receipt and letter) Type: Choose one Quantity:
Type: Choose one Quantity:
3c. Comments:
4 Complete if Makinq a Payment to In-lieu Fee Prc
4a. Approval letter from in-lieu fee program is attached.
46. Stream mdigation requested:
4c. If using stream mitigation, stream temperature:
4d. Buffer mitigation requested (DWQ only):
4e. Riparian wetland mitigation requested:
4f. Non-riparian wetland mitigation requested:
4g. Coastal (tidap wetland mitigation requested:
4h. Comments:
5. Complete if Using a Pertnittee Responsible
❑ Yes
linear feet
Choose one
square feet
acres
acres
acres
Plan
5a. If using a permittee responsible miligation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form—Version �.4 January 2009

6. Buffer Mitigatian (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 iden6iy the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6a 6d. 6e.
Zone Reason for impad Total impad Multiplier Required mftigation
(square feet) (square feet)
Zone 1 3(2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. It buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
pertnittee responsible riparian buifer 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 Pian
1 a. Does the project include or is it adjacent to protected
wltnin nna nfthe NC Rioarian Buffer Protection Rule:
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
2 Stormwater Manaaement Plan
2a. What is the overall percent imperviousness of this project?
Does this
buffers identified
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
no new Impervious surtace
❑ Yes ❑ No
� Yes ❑ No
0%
❑ Yes � No
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
NA
2e. Who will be
Local
for the review of the Stormwater Management Plan?
3b. Which of the following locally-implemented stormwater management progrems
apply (check all that apply):
3c, Has the approved Stormwater Management Plan with proof of approval bee�
attached?
4a. Which of the following state-implemented stomtwater management programs apply
(check all that apply):
4h. Has the approved Stormwater Management Plan wfth proof of approval been
5a. Does the Stormwater Management Plan meet the appropriate requirements7
Sb. Have all of the 401 Unit submittal requirements been met7
NA
❑ Phase II
❑ NSW
❑ USMP
� Water Supply Watershed
� Other:
❑Yes ❑No
�Coastal counties
❑HQW
❑ORW
❑Session Law 2006-246
❑Other:
❑ Yes ❑ No
❑ Yes � No
❑ Yes � No
Page 8 of 10
PCN Fortn — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ R¢quirement)
1 a. Does the project involve an expendRure of public (federaVstate/lopl) funds or the ❑ No
use of public (federaUstate) land? � Yes
1 b. If you answeretl "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) Ernironmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized 6y the
State Clearing House? (If so, attach a copy of the NEPA or SEPA finai approval
letter.) ❑ 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 � No
or Riparian Buffer Rules (15A NCAC 26 A200)?
2h. 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 anticipaled future impacts) resutt in
additional development, which could impact nearby downstream water quality? ❑Yes � 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 narralive description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) ofwastewater generated from
NA the proposed project, or available capacity of the subjecl iacility.
Page 9 of 10
PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requlrement)
5a. W II this project occur in or near an area with federally protected species or � Yes ❑ No
habitat?
5b. Have you checked with the USFWS conceming Endangered Species Act � Yes ❑ No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted. Asheville
Sd. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Naturel Heritage Program GIS databese. After discussing wHh Jay Mays, USFWS, we believe there will be a May EHed Not likely to Adversely effed,
due to the lack of habRat in ihe project vidnity.
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 souroes did you use to determine whether your site would impact Essentiai Fish Nabitat?
7. Historic or PrehisWric CulWral Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
govemments have designated as having historic or cultural preservation � Y� � No
status (e.g., Nationai Historic Trust designation or properfies significant in
North Cerolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historlc or archeologicai resources?
No evidence of historic resources o� site
8. Flood Zone DesignaUon (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ❑ Yes �X No
8b. If yes, explain how projed meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
/��,y ��.�,� . y� 31 �°��t
Appiicant/AgenYs Printed Name IicanUAgenYs Signature Date
(AgenYs signature is valid onty'rf an authonzalion
letter from the a IicaM is rovided.
Page 10 of � 0

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