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T'h� s��+��°� �c� �►��:+d �d� �.�►� ��.�v� �� +��. tc�p� ����. �tr�ar:� ��.p��t� �� ���►u����+� b���►�a Str�a� Irn�r�+�ts: The re�lac�rn�nt c�f th+� a�bo�� :�t�t�d �vvet pipe ��ill r��u�r� �+��n.pc�ra��y �e�a��r�n�. A� imp+er��.c�u� s�,n.d�►ag d�ke ��I be �onstru�t�e�. �p��r�eam c��` th� ��:i�ti�� pi��e t+� �r�a.�+� a sm�l paal. �;1��,�. �ra��r vvill t�mpe�rarily b� pum�+�d a�rc�un�+d th� �a►nst:r�.�ti�� �-��. �n� ��ll �r� c�i��h�.�r�ed d�►�m►��r�e�r.�►. Aa�y� �lirty wat�r l�c�t�d ins�d� +�f t�� ��r��truc�ica�: �r+e� ���1 be �►u�rn�ec� i�.�+� a�il� �a�.,� i� n���s�a�:�y. �`� '� � i ����� � !�' � � �C A� " ! : `,� ��!; � i �r �• � � • r�► . � � � �� �!�r. .��:dy ��11��rn� ��t. �� 1 �3, �r��e�b��ry L�►e, �V�1�.�� F��e � A�►�il �9, 2�1� ��►c� t�+� n+��r �►i�+� i� i�: p��.ce� �h+� i:r�p��r�i�►u� d�k� �i�� be �em��ve�: ��.d �r+���►���ruc�t��� �t�r��a:����d �l�v,�����.� �v�l b� r�s��c�r+�d. �"�� �v�t p�pe ia� �u�s�i��. ���i.+�� � �CTT �c� :�i�h��.� t��r��� ��l��s: ��. "�h�:� p�rc�je�t ��s �r�v���+��. �`�a� ��+� �►r���:��e �►�' �l�re�t�n�+� �.�.c� e��ar���r�+� �p+��c��� �►� .�.���.�� �, �� � � . "�.�:�� ���j��� �i�� �i��� r�� �:�`��� �n �:�� �"��+�ra11� li�t+�d ��.�a�.,��r�� p1�:r�t c�r �a�.r��� �p+�+����. :��st+a�.� ��►�.�1i�:�.�� ��r:� �.�.� b��r� ��►rnpl�t�d. '�h� �r�j��t in��a+��� a�r� r�c�t si��i�c�;ni �n n,�tur� �.�. shc�u�� r�c�i r���:c��� �r +���r�.c�� ��.��in� ��t��r ��u�1���r �s��s. �tc�rm�at�r ���� b►� r��a��� t�c�u�� ��,ss ��r r��:� 1��.�d �������, ��p���d��.� �r� �h� dit�� �i�.� �1���. �'i�►� �i��s u.��d ��i�� �+� ��.+e ��r.urn�:�. �������r� ��► +�r+���� � ���'+� r�►���,��. :�� �ti�iz�in� �h� +�r�s�a� �c�n�r�e�� m+��.���e� c��tli��d �r� ��+� �t��+�:�r���.t� �c� ��s ����i���i��., �c������� w�.�+�r t�uality �t,�nd�rc�� w�ll be p�r+�t�ct�d. !�}v�er�,ll �w�.�+er q�a�:it� � th� �r��� ��.�1 �� i�pr°+��v�d� �►� pav�.�,� th+� .��� tr���e� ����. Ai� �p�►r°c��►ri�.t+� �I��� v�ii� 1�� �.�d d��.r��,� ��►�����ti��.. .A.t�a�h�+� i� � Pa~e��►n�tr�ction �T�►t��i�ati�� :F�r��., �la��. ����t� ��:t� ��r�►��►�+�� �r�►�'�r� �+��►��r�►� �.+�a�ur���� � �narl���. ��u�.t�r n��p ��� � �a��°��+� �t�p�+�,�r��►�� :�.��� i�y� ��py c��this +�1��t�ranic ��t�t�r� it i� r��u��e�t+�� t�:at i���. ���r�� +����►�r� v�i�t�i �t�.� ��►�t�: ��,rr�►����. "V�il�1i�+� �t.�sa�ur�+�� ���r��.��i��. ��►n��r��nt �i�r����� t� �o�. c�►�+����ir�;� ��� 4�4 ��.�������� ������ ap�pli�ati�►� v�►�th �, ���y ��n.t t� �n�. �►�r c��►y ��` ��ai� �l��tr�:�ic l+ett+�r, i� �� r��qu+�s�+��. t�i�t t�:� :�3��°���.�r� c��` ��'���r �.�.��y, 4�� � I���t��:��� �Tr�it� '�s�a� �he �.��►ra�ri�t� ���r�i� �'ar +���:s�r�+����►�: +��` t�.� p�r�j��. �i i� r��r����t�d ��:,�t ���' �ar��r�+��:ts �+el�.�t�d t+� th�� �4t� � rer�i�i������ �� ��►�r��rd�c� �ir��t�� t� �� ���t�i � ���� ���.� �� ��� �T� Aa�:�� �c�r�ps t��':��. .,%�+��r�. ��'+e �r�uld li�+� �� �a��� ���.�truc�i+��. �� �+���. �� �+�s�ib�+�. � ��th�r ir����r�:��i��. �� r�q�.i���� �►�+��.�� �+�t m� ����vv. '�c�ur ��r1� r�vi�� ��� �+ans�c��r��ic�� ��� �� �.p�►re���.��d. M � { �� . V �� N � , � � �������'" � ��� �� `� ,� � r „ � , � t M +1 • , � � ''. ! �i. . � � . . �,r���o�u�r�� �+�: l��arl� �h�a:�b�r�,1'�C��V��.� .��rn�r �hap�n�r�, �►iv�i�it�� s��' �V��.t��r ���.��� �►�v� �����+���, T�►�v�si�►�. +��' �'��.t�� +�►��it� i��.l�e �'et�i�€�hur�., �'�,, T�i�n���r� �,��i�:���° I�c�u� `T'�t��i�', :�i�t�.�� :�.��.i�.�+�r �t��r� ��by� ���u�.ty� ���.r�t����+�� �n�i���r :C�+�at� ��a�u�ht�r� 1�►��i�i+�n :�nvi�r+��u�a�nt�1 t���.��r ��.a�+� T'�.r+e�:���d�, �.aad���.+� :�r��rir�n�r�+����. �"�e�� �►����.�ic��� "�+��ha����.� �� � � ���' �.�, �� dffice Use tJnly: � � Corps actian I D na. � �. � � �` -� DWQ rc��ect no. � � � � "��� ?������������; P 1 ������ Fa�rm Version 1.3 Dec 14 2�Q8 �'�r�-Cons�ructi+�n Noti�icati�n �'CGI� �'or A. A licant Information 1. Prbcessing 1 a. Type(s) of approval sought from the ��� S: � Section 404 Permit [� Sectic�n 1Q Permit p 1 b. �pecify Nationwide Pe�rmit {NWP} number: 14 or General Permit {GP} number: 1 c. Has the NWP or GP number been verified by the Carps? ❑ Yes � No 1 d. Type{s} of approval sought frorn the DWQ (check all that apply): � 441 W�ter Quality Certification — Regular ❑ N�n-4�U4 Jurisdiction�l General Permit ❑ 40'1 Water Quality Certification — Express 0 Riparian Buffer Authc�riZation 1 e. Is this notification solely for the record For the record c�niy for DWQ 401 For th� rec�rd only for Corps Permit: because written approvai is nofi required? Cerkification: ❑ Yes � Na ❑ Yes � No 1 f. Is payment into � mitigation bank or in-lieu fee program proposed for mitigation � Yes � No o f impac ts? 1 f sa, a t tac h t he �ccep tance le t ter fram mi tiga tio� b�n k or in- lieu fee prc�gram. 1 g. Is the project lacated in any of NC's twenty coastal counties. If yes, answer 1 h ❑ Yes � No below. 1 h. Is the project located within a NC DCM Are� of Environmental Concern (AEC)? � Yes � Na 2. Project Information 2a. Name nf project: SR 2610, Greenberry Lan� 2b. County: Wilkes 2c. Nearest municipality / town: Nc�rth Wilkesbaro 2d. Subdivision n�me. 2e. NCDC7T only, T. I. P. or state 11 C.097167 project na: 3. CJwner lnfiorm�tion 3a. Name{s) on Recarded Deed: NCDCJT . 3b. Deed Book and Page No. 3c. Responsible Party (for LLC if applicabl�): 3d. Street address: 801 Statesville Road 3e. City, state, zip: Narth Wilkesboro, NC 28�59 3f. Telephane no.: 336-903-9202 3g. Fax no.: 33�-�67-4549 3h. Email address: hslaughter��ncdafi.gov Page 1 of 10 P�N Form -- Version '1.3 December 1 O, 2U�8 Version 4. Applicant Information (sf different from c�wner) 4a. Appiicant is; ❑ Agent ❑ Ofiher, specify: 4b. Name: 4c. Business name (if applicable): 4d. Street address: 4e. City, state, zip: 4f. Telephone no.: 4g. Fax no.: 4h. Email address. 5. Agenfi/Consultant Information (if applicable) 5a. Name: 5b. Business name (if applic�ble}: 5c. Street address: 5d. City, state, zip: 5e. Telephone no.: 5f. F�x no.: 5g. Email address: Page 2 of 10 PCN Form -- Version 1.3 Decernber 14, 20a8 Ver�ic�n B. Prc�ject tnformation and Prior Projec� History 1, Property Identificatic�n 'I a. Property identification no. (t�x PIN or parcel ID): 1 b. Site coc�rdin�tes (in decimal degrees): L�titude: 36.14�44 Longitude. - 81.�8819 (DD. DD�DDD) (-Da. DDDDDD� 1 c. Property size: 1.4 acres Z. S u rfac�e Wate rs 2a. Name o�F near�st body of water (stream, river, etc.) to UT t� Fishing Greek proposed pra�ect: 2b. W�ter Qu�lity Classification of nearest receiving water: C 2c. River b�sin: Y�dkin 3. Project Descript�on 3a. Describe the existing conditions on the site and the general I�nd use in the vicinity of the project at the time of this application: � � Unpaved road in a rura! area. 3b. List the total estimated acreage of all existing wetlands c�n th� properky: 4 acres 3c. List the total estimated linear feet of ail existing streams (intermittent and per�nnial) on the property: 45 linear feet 3d. Explain the purpose of the proposed project: Upgrade roadway as part of road addition. 3e. Describe the overall project in detail, including the type Qf eq�uipment to be used: See attachec� cover letter. 4. Jurisdictional Determinatians 4a. Have jurisdiction�l wetland or stream determinations by the Carps or State been requested or obtained for this property I project (including all prior phases} in the past? ❑�'es (�j No [� Unknawn Camments: 4b. If the Corps made the jurisdictional determination, what type of determinatian was made? � Preliminary [,� Final 4c. If yes, who delineated the jurisdictional areas? Agency/Cansulfiant Cornp�ny: Name {if knovvn): C�ther: 4d. If yes, list the dates af the Corps jurisdictional determinations or State determin�tic�ns and attach documentation. 5. Project His�ory 5a. Have permits or certifications been requested or obtained for � Yes � No ❑ Unknown th�s pro�ect (rncluding all prior phas�s} in the past? 5b. if yes, explain in detail according to "help fiife" instructions. 6. Future Prc��ect Plans 6a. 1s this a phased project? C] Yes � No 6b. If yes, explain. Page 3 c�f 10 P�N Form — Versian 1.3 December 1�, 20�8 Ver�ion C. Proposed Imp�cts Inventory 1. Imp�cts �ummary 1a. Which sections were compieted below for ynur proje�t (check all that apply): � ❑ Wetlands � Streams - tributaries ❑ BufFers �] CJpen W�ters ❑ Pand Construction 2. Wetland impacts If there are wetland imp�cts propo�ed on the site, then compiete this question for each wetland area impacted. 2a. 2b. 2c. 2d. 2e. 2f. Wetland impact Type c�f jurisdiction number — Type of impact Type of wetland Forested (Corps - 4�04, 1 a Area of impact Permanent (P) or {if known) DWQ — non-4�4, other) (acres) Tem ora T ❑ Y�s ❑ Corps W1 ❑ P❑ T N� DWQ ❑ ❑ [� Yes ❑ Corps W2 ❑ P❑ T N� DWQ ❑ 0 ❑ Y+�s [� Corps W3 ❑ P❑ T No DWQ ❑ ❑ ❑ Y�s ❑ Carps W4 ❑ P❑ T N o DWQ 0 ❑ ❑ Yes � Corps W5 ❑ P❑ T N� DWQ ❑ ❑ [� Yes [� Corps W6 ❑ P❑ T Nq DWQ ❑ 0 2g. Total wetland impacis 2h. Camments: 3. Stream Impacts If there are perennial or intermittent stream impacts (including tempor�ry impacts) proposed an �he site, then complete this question for all stream sites impacted. 3a. 3b. 3c. 3d. 3e. 3f. �g. Stream impact Type of impact Stream name Perennial Type of jurisdiction Average imp�ct number - (P�R} or (Corps - 4�4, 10 stre�m len9th Permanent (P) or intermittent DWQ -- non-404, width (linear Temporary (T) (Ii�T)? other) �feet) feet) Pipe, Riprap & UT to Fishing � PER � Corps 51 � P�) T Dewaterin Creek INT DWQ 1 �� 9 ❑ � ❑ PER [] Corps S2 ❑ P❑ T lNT DWC� ❑ ❑ ❑ PER ❑ Carps S3 ❑ P❑ T I NT DWt� ❑ ❑ �j PER [� C�rps S4 ❑ P❑ T INT DWQ 0 � ❑ P�R [.� �orps S5 ❑ P❑ T INT CJWQ ❑ ❑ ❑ P�R ❑ Corps S6 ❑ P❑ T I NT aWQ � ❑ 3h. Total stream and tributary impacts 6� 3i. Comments: 16 pipe, 1 � riprap, 4� dewater Page 4 of 10 P�N Form -- Version 1.3 December 1�, 2048 Ver�ion 4. C�pen Water Impacts If there are praposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic C�cean, or any other open vti+�ater of the 1J.5. then individually list all open water impacts below. 4a. 4b. 4c. 4d. 4e. t�pen water Name of waterbody impact number — (if appiicable) Type of impa�t Waterbody type Are� of imp�ct {�cres) Permanent {P) or Tem ora T 01 ❑ P❑T 02 [�]P❑T 03 QP❑T CJ4 ❑P❑T 4f, Total apen water impacts 4g. Comments: 5. Pond or �ak� Constructian If ond or lake construction ro osed, then com lete the chart below. 5a. 5b. 5c. 5d. 5e. Wetland Impact� (acr�s} Stream imp�cts {feet) Upi�nd Pond lD Propos�d use ar purpose (acres) number a� p�n� Flooded Fiiled Excavated Floc�ded Filled Exc�v�ted Flooded P1 P2 5f. Total 5g. Comments: N/A 5h. ls a dam high hazard permit required? ❑ Yes (�j �lo If yes, permit I� no: 5i. Expected pand surface area (acres): 5j. Si�e of pand watershed (acres}: 5k. Method of construction: f. Buffer Impacts (for DWQ) If project will impact a protected riparian buff�r, then complete the ch�rt below. If yes, then individually list afl bufiFer impacts below. if �n impact� r�quire miti ation, then ou MUS�' fili c�ut �ection D of this form. 6a. ❑ Neuse [� Tar-P�mlico ❑ tJther: Project is in which protected basin? ❑ Catawba 0 R�ndieman 6b. 6c. 6d. 6e. 6f. 6g. BufiFer impact number -- Reas�n Buff�r Zone 1 impact Z�ne 2 imp�ct Permanent (P} or for Stream name mitigation (squ�re feetj (�quare feet} Tem ora T im act re uired? ❑ Yes g1 ❑ P ❑ T ❑ I�o ❑ Yes B2 C]P❑T �No ❑ Yes �� �p�T ❑No 6h. Total bu�fer �mpacts 6i. Comments: Page 5 c�f 10 P�N �'orm — Version 1.3 Dec�mber 1�, 2U08 Version C�. lmpact Justification and Mitigation '1. Avoidance and �Vlinimization 1 a. Specificaily describe measures taken to avoid or minimize fih� proposed impacts in desi�ning project. The pipe length is the minimum needed to improve roadway. 1 b. Specificaily describe measures taken ta avoid or minimize the propo�ed imp�cts through constructic�n techniques. Ali �ppropriate BMPs will be used during construction 2. Campensator� Mitigatian for lmpacts to '�IVaters of the U.�. or Waters of �th� Siate 2a. Dc�es the project require �ompensatory Mitigation for ❑ Y�s � No impacts to Waters of the U.S. or Waters af the State? 2b. If yes, mitigatiQn is required by (check all that apply): [] C�WQ ❑ Corps ❑ 1�iifiigation b�nk 2c. ff yes, which mitigation opfiic�n wiil be used for this �.�.��t? [� �ayment fic� in-lieu fee program p � [] (�ermittee Responsible Mitigation 3. Gomplete if Using a Mifiigation Bank 3a. Name of Mitigation Bank: 3b. Credits Purchased (attach receipt and letter} iype Quantifiy 3c. Comments: 4. Complete if Making a Payment to In-Iieu Fee Program 4a. Approval letter from in-lieu fee program is attached. [� Y�s 4b. �tream mitigation requested: linear feet 4c. If using stream mitigation, stream temperature: [� w�rm ❑ coc�l ❑c�1d 4d. Buffer mitigation requested (DWQ only}: squ�re feet 4e. R.iparian wetland mitigation requested: acres 4f. Non-riparian wetland mitigatian requested: acres 4g. Goastal (tidal) wetland mitig�tion requested: acres 4h. Comments: 5. Complete if Usir�g a Permittee R�sponsible Mitigation P1an 5a. If using a permittee responsible mitigation plan, provide a description of the propased mitigation plan. Page�ofi1Q P�N Form -- V�rsion 1.3 D�cember 1�, 2408 Versian 6. Buffer Mitigation �State Regulated Ftiparian �uffer Rules) — r�quired by C�WQ 6a. Will the project result in an impact within a protected riparian buff�r that requires ❑ 1�es � Na bufFer mitigation? �b. If yes, then identify the square feet of impact to each zone of the riparian buffer th�t requires mitig�tion. Calculate the �mount of mitigation required. 6c. 6d. 6e. Zone Reason for impact Total impact Multipiier Required mitigation (square feet} (square feet) Zone 1 3 (2 for �atawba) Zone 2 �.5 6f. Total buffer mitig�iian requir�ed: 6g. If buffer mitigation is required, discuss what type of mitigation is propc�sed (e.g., payment to private mitigation bank, permittee responsible rip�rian buffer restoration, p�yment into �n �pproved in-lieu fee fund}. �h. Comments: P�ge 7 of 10 F�CN Form --Versian 1,3 December 1�, 2�08 V�rsion E. Stormwater Management and Dififuse Fiow Plan (required by �WQ) 1. Diffuse Flow �'lan 1 a. Does the project include or is it adjacenfi to protected riparian buffers identified ���s � Na with�n one of the NC Riparian Buffer Protection Rules? 1 b. If yes, then is a�diffuse flow pian included? If no, explain why. C� Y�s ❑ N c� Comments: Z. Stormwater Mana ement Plan 2a. Wh�� is the over�ll percent imperviousness of this project? % 2b. Does this project require a Stormwater Management Plan? ��es ❑ No 2c. If fihis project DOES NC?T require � Stormwater Management Plan, explain wh�: 2d. If this project DCJES require a Stormwater Management P1an, th�n provide a brief, narrative description of the plan: Falls under DC�T NPDES Permit ❑ Certified L.oc�l Governm�nt 2e. Who will be r�sponsibie for the review of the Stormwater Management Plan� ❑ CJWC� Stormwater Progr�m ❑ LJWQ 4�1 Unit 3. �ertified Local Government Stormwater Review 3a. In which locai government's jurisdiction is this project? ❑ Phase II 3b. Which of the followin locali -im lemented stormwater mana err�ent ro rams � N�� 9 Y p � p 9 ❑ USMP apply (check all that apply): ❑ Water Supply W�tershed ❑ Other: 3c. Has the �pproved Stormwater Management Plan with praof of �pproval been [�j Yes ❑ No attached? 4. C�V1/Q Stormwater Pro ram Review (� �o�stal cc�unties 0 H �2� 4a. Which of the follawing state-impiemented stnrmwater managem�nt programs apply � p�� (check all th�t appiY): ❑ �essic�n Law 2�cJ�-�46 ❑ Other: 4b. Has the approved Stormwater Management Plan with pro�f of appraval been at�ached? ❑ Yes ❑ No 5. DWQ A��1 Unit Starmwater Review 5a. Daes the Stormwater Managerr�ent Plan meet the �pprapriate requirements'? � y�� ��Q 5b. Have all of the 401 Unit submittal requirements been met? ���� ❑�� Pa�� S of �o P�N Form — Version 1.3 Qecember 10, 2008 Version F. Supplementary information 1. Environmental Documentatifln (DWQ Requirement) 1 a, Daes the project involve an expenditure of pubiic (federal/state/lo�al) funds or the ��.�5 ��� use of pubi�c (federal/state) land? 1 b. if you answered "yes" to the above, does fihe project require prep�ration of an environmen#al document pursuant ta the requirements of the National or State (� Yes � No (North Carolina) Enviranmentai Policy Act (NEPA/�EPA)? 'I c. If you answered "yes" to the abave, has the document review be�n finalized by the State Clearing House? (if so, attach a copy of the NEPA or :�EP� �nal approvai letter.) ❑ Yes ❑ N� Comments: 2. Violations (DWQ Requirement} 2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .�5a0), lsolated Wetland Rules {15A NCAC 2H .1300), DWQ �urface Water �r Wetl�nd Standards, ❑ Yes � No ar Riparian Buffer Rules {15A NCAC 2B .q200)? 2b. Is this an after-the-fact permit application� ❑ Yes � Nc� 2c. If you answered "yes" to one or both of the above questians, provide an explanation of the violati�n{s): 3. �umulative impacts ��WQ Requirement) 3a. Wiil this project (based on past and reasonably anticipated future impact�} resuit in � yes � No additional developrnent, which could impact nearby downstream water quality? 3b. If you answered "yes" to the above, submit a qualitative or q�antitative .cumulative impact analysis in accordance with the most recent D1NQ policy. If you answered "no," provide � short n�rrative description. 4. Sewage Disposal (DWQ Requirement) 4a. Clearly det�il the ultimate treatment methods and disposition (nor�-discharge ar disch�rge} of wastew�ter gener�ted from the proposed project, or available cap�city of the s�bject fa�i(ity. N/A Page9�f1Q PCN Form — Version 1.3 December 10, 2048 Version 5. Endangered Species and Designated Griticai Habitat (Ct�rps Requ�rement) 5a. Wili this project occur in or near an area with federaily protected �pecies or � Y�� ��Q habitat? 5b. Have you checked with the USFWS concerning Endangered Sp�cies Act C] Yes � No i m p�cts'? ❑ R�leigh 5c. !f yes, indicate the U�FW� Field Office you have contacted. [� Asheville 5d. What data saurces did you use to determine whether your site would impact Endangered Species or Designated Critic�l H�bitat? GiS �nd visual observation �. Essential Fish Habitat {Corps Requirement) 6a. Vi/iil this project accur in or near an area designated as essential fish habitat? ❑ Yes � Nc� 6b. What data sources did you use to determine whether your site wouid impact Essenti�l Fish Habitat? WRC will comment 7. Historic or Prehistaric Cultural Resources (�arps Requirement) 7a. Will this project occur in or near an area that the state, federai or tribal governments have d�signated as having historic or cultural preservation .�,,es � Nc� Tr st desi nation or ro erties si nificant in � status {e.g., Natic�nal Histor�c u g p p g North Carolina history and archaeoiogy)? 7b. What data sources did you use to determine whether your site would impact historic or archeological res�urces? Project submitted to HEU 8. Floc�d Zone Designation tCorps Requirement} 8a. Will this project occur in a FEMA-designated 100-year flaodplain? (� Yes � No 8b. lf yes, explain how project meets FEMA requirements: 8c. What saurce(s) did you use to make the floodplain determinatior�? ncflaadmaps J. I�eath Slau hter '������ � � � ��� A licant/A ent's Printed N�me �.pplic�nt/Agent's Sig ure D��� pp � (Agent's s nature is valid only if an authariz ' n letter fram the applicant is provided.} Page 1 � of 10 PCN Form — Version 1.3 December 10, 20�8 Ver�ion 1�t,� � �,n� •...,. 'd�, . �� � ,,, STATE OF NORTH CAROLINA DEPART2VIENT OF 'TR:ANSPORTATICJN . PA'I'Ri�K L: IVIGCRORY - _ _ __ __ _ __ . __ANTHONY J. TATA __ GOVERNOR SECRETARY March 18, 2014 MEMOR.ANDLTM TO: Heath Slaughter Division Environmental Officer FROM: Christopher C Absher, P Assistant District Engineer SUBJECT: Permit Application Information far SR 2610 (Greenberry �ane) in Wilkes County Attached for your further handling is the requested information for obtaining the necessary permits for the improvement and addition of SR 2610 (Greenberry Lane) in Wilkes County. I have included the roadway construction plans, erosion control plan, a county map, and a Topographic map indicating the location of the project. The above project will consist of grading and drainage of SR 2610. The improvements wil! begin at Station 00+00 and will end at Station 13+91. The total length of the project is 0.26 miles. As noted on the Minimum Criteria Determination Checklist, there is one wet pipe on the project. The average existing width of SR 1305 is 13 feet and the proposed width is 18 feet with a total right-of-way of 45 feet. There are no historic buildings or other significant sites within the proposed right-of-way of this project. 8hould you require additional information, please call. CCAJcca Attachments cc: M. A. Pettyjohn, P.E. Brian HambyP.E. P.O. Box 250, North Wilkesboro, NC 28659 Phone: (336) 903-9146 F�: (336) 903-9219 MINIMUM CRITERIA DETERNIINATION CHECKLIST The following questions provide direction in determining when the Department is required to prepare environmental documents for state-fiinded construction and maintenance activities. Answer questians for Parts A through C by checking either . _ `=l�es" or "No�'� Complete P�xt I3 of t1i� cl�ecl�I��t �l�en Mi�u�iurt� e�teri�R�t� ___ _ ___. categories #8, #12(i) or #15 are used. TIP Project No.• State Project No.: 11C.097167 Project Location: SR 2610 Greenberrv Lane, Wilkes County, NC Project Description: Grade and Drain Anticipated Permit or Consultation Requirements: Special Project Informatian: There is one stream crossings within the project limits and na si 'iYi� ficant structures tliat will be impacted by this proje�t. No trout buffer variance will be needed on this pra�ect 03/18/14 1 of4 PART A: MINiMUM CRITERIA Is the proposed project listed as a type and class of activity allowed under the Minimum Criteria Rule in which environmental documenta,tion is not required? � 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? 8 If either category #$, # 12{i) or # 15 is used, complete Part D af this checklist. PART B: MINIMUM CRITERIA EXCEPTIONS �te»�s 2,,� 4 tr� be �r�»:p�eted hy the E�igr�eer� ;: 2. Could the proposed activity cause significant changes in land use concentrations that would be expected to create adverse air quality impacts? 3. Wiil the proposed activity have secondary impacts or cumulative impacts that may result in a significant adverse impact to human health or the environment? 4. Is the proposed activity of such an unusual nature or does the propased actiivity have such widespr�ad impli�ations, that an uncommon concern for its environmental effects has been expressed to the Department? YES NO ❑ � � � ���s:l 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? 6. Will the proposed activity endanger the e�cistence of a species on the � � Deparhnent of Interior's threatened and endangered species list? 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? 03/18/14 2 of 4 ❑ ❑ YES NO 8. Is the proposed activity expected t4 have a significant adverse effect on � � long-term recreational benefits or shellfish, finfish, wildlife, or their natural habitats If any questions 2 thraugh $ 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) �33 —3141 Fax: {919) 733-9794 PART C: COMPLIANCE WITH STATE AND FEDERAL REGULATIONS 9. Is a federally pratected threatened or endangered species, or its habitat, likely to be impacted by the proposed action? 10. Does the action require the placement of temporary or permanent fill in waters of the United States? 11. Does the project require the piacement of a significant amount of fill in high qua.lity or relatively rare wetland ecosystems, such as mountain bogs or pine sava�nahs? 12. Is the proposed action located in an Area of Environmental Concern, as defined in the coasta.l Area Management Act? ��%�ns 13: i�` tQ I�e �omp��ed liy t�e ��g�c�eer : 13. T3aes the �roject require str�arn reloc�tion or channel changes? Cultural Resources 13. Will the project have an "effect" on a property or site listed on the Natianal Register of Historic Places? 14. Will the propased action require acquisition of additional right of way from publicly aumed parkiand or recreational areas? YES NO ❑ ❑ ❑ � ❑ ❑ ❑ � ❑ � ❑ � ❑ � Questions in Part "C" are designed to assist the Engineer and the Division Environmental O�cer in determining whether a pernut 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. 03118t14 3 of 4 PART D: t To be completed when either cate�orv #$, #12(i) or #15 af the rules are used. _ "���,��`��� f� ��"����������'�i����r�r��`t�tif�,��; � ���x _ __ _ 15. Project length: 16. Right of Way width: 17. Praject completion date: 18. Tota.l acres af newlv disturbed ground surface: 19. Total acres af wetland impacts: 20. Totallinear feet of stream impacts: 21. Project purpose: 4.26 MILES 4S FEET JANUARY l, 2015 1.5 ACRES IMPROVEMENT If Part D of the checklist is completed, send a copy of the entire checklist document to: Don G. Lee State Roadside Environmental Engineer Mail Service Center 1557 Raleigh, NC 27699-1557 (919) 733-2920 Fax (919}733-9810 Emaii: dlee@dot.state.nc.us Reviewed by: Date: �'�1 G� J Lead gine�r Date: Division Environmental Officer cc: Don Lee 03/18/14 4 of 4 . � � �' � �. •. � � . a � � � 3 4 �� �� �3 ( r/ a� s� .:- �� v� � z / ► _. :: � � � I"1 I"1 � � o a. ::��. .�� : : � , � � �.�; 'M' ►+ �. U 8. 8� �3, � f" H � E Fp�., E g b y �� _� .� ~ .. � �/ �1 �V � p� . v . , a u � ^�o� v� . � ; E�`„ G� U ,^w U ' W � V q � . � � = W .�w .�� y �� y � r � � . � � � .A � . iy } � � � 7° $ A w ro � b' d O� o cF� B a� F; u� A °� � a.b CS �iti �p h h M ^ ^ A n y M �. _4 Y C Y F� � � + Y O • Mp V, Yp � ip Yp ►�1 i M a M � (i b 4 .ii�.) 0. 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