20140996 Ver 1_Application_20140918

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STATE (�F NORT�I C�.ROLINA
DEPARTMENT i�F TRANSPt�RTATI(JN
PAT McCRORY P. O. Box 25201, Ra1e1g1�., �1� 27b11-5202
GOVERNOR PHONE: [phone]
S eptember 17, 2 014
Mr. Andy V�illiams
I.�. S. Army �orps of Englneers
Raleigh R.egulatory Field (�ffice
3 3 31 I�er�tage Trade Drive, Suite 1 QS
Wake Farest, NC 275 87
� �
.
Subj ect: Nationwide Permit #3
Bridge #21 n scour repalr an SR 15�8
Watauga County, Narth Carolina
Project Number: 118.209511 (No D�R Permit Fee Requiredj
Dear Mr. Wllliams:
We have experienced substantial scour damage tc� the footer of ane o� aur int�ric�r bents under �he
subject bridge. This was a"prompt action no�ice" so corrective action has already been taken. I�
order to correct this situatian vve have packed ro�k under the scoured fo�ter 125 �`t� ar �.0�3
�
acres) and installed 25 linear feet of bank stabllization.
Bri�.ge #210 crosses Elk Creek (Class: B; Trout, O�Z.W). Th�s project had no effe�t �n any
federally listed endangered plant or an�mal specles. The praj eci was exe�npt �`rom h�siorical
review.
Attached is a Preconstruction Notification Form, plan sheets, a marked county map, a marked
topagraphy map and photographs.
By copy af this letter, it is requested that Mrs. Marla Chambers, Mc�u�tain :�.e��or� �oardinatc�r,
with the North Carolina Wildlife R.esources Commission commeni directly �o you cc�ncernin� the
404 Nationwide Permit application with a copy sent to me.
If further informatian 1s required, please l�t me kn�w. Yau�r early review �.nd consid�rat�on vv�ll
be appreciated,
Sincer�ly,
�
I-ieath Slaughter
Divisian �,nv�ronm��.tal CC�fficer
P. C�. BOX 250, N. �1VILKE5BOR0, NC 2S6S9
PHO�E (336) �67-9111 Fax {336) 667-454�

Mr. Andy Williams
Bridge #210 on SR. 1508
Page 2
September 17, 2014
Enclosures
cc: Marla Chambers, Mauntain Region Coordinator,l�TCWRC
Am� �hapman, Divisian af Water C�uallty
11�Iike Pettyj ohn, PE, Dlvisian Engineer
David VV`ayne, PE, Bridge lVlaintenance Engin��r
I-ieath Slaughter, Division Environmental C�f�'i�er
Zack Souther, Roadslde Environmental Field Operations Techr�icia�

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��4� � ,, � OfFice Use Only:
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� � � � ���,.3 " ' . DWQ praject no.
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'....:`;'�����j .... Form Version 1.3 Dec 10 2�U8
Pre--Constructio� Notifica�tion I'C�T :�orn�
A. A licant Information �� �
1. Processing
1a. Type(s} of approv�l sought fram the �ection 4Q4 Perr�i# �ection 1� P rmi
Cor s: � � � t
p
1 b. Specify Nafiionwide Permit (NWP) number: 3 or General P�rmit (GP} number:
1 c. Has the NWP or GP number been verified by the Corps? ❑ Yes ��lo
1 d. Type(s) of approval sought from the �WQ (check all that apply):
[� 4�1 Water Quality Certification — Regular [� Non-404 Jurisdictional General Permii
❑ 401 Water Quality Cert�fi�ation -- Express ❑ Riparian Buffer AuthoriZatian
1 e. Is this natification solely for the record For the record only for aWQ 4fl1 For the record anly far Corps �'ermit:
because written approval is not required? Certification:
� Yes ❑ No ❑ Yes � No
1 f. Is payment into a mitigation bank or in-lieu fee program propased for mitigation ���� � Na
of impacts? ff sa, attach the acceptance letter from mitigation bank or in-lieu
fee pragram.
1 g. Is the project located in any af NC's twenty coastal counties. If y�s, answer 1 h ❑ Yes ��lo
below.
1 h. Is the project located within a RIC DCM Area of Environmental Concern (AEC)? ❑ Yes (� Nr�
2. Project Information
2a. Name of project: Bridge #210 Scour on SR 1508
2b. County: Watauga
2c. Nearest mur�icipality / town: Darby
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state 118.209511
project no:
3. Owner Information
3a. Name{s) on Recorded Deed: NC Dept. of Transportation
3b. Deed Book and Page No.
3c. Respansible Party (fcar �L.0 i f He�th Slau hter
applicable): g
3d. Street address: P. C�. Box 250
3e. City, state, zip: North Wilkesboro, NC 28659
3f. Telephone no.: 336-9q3-9242
3g. �ax no.: [phone]
3h. Email address: hsfaughterC�ncdot.gov
Page 1 af 10
P�N Form -- Version 1.3 Decer�ber 1�, 2U08 Versiar�

4. Applicant Information (if different from owner)
4a. Applicant is: ❑ Agent ❑ tJther, specify: ���� ����
4b. Name:
4c. Busines s name
(if applicabie):
4d. Street address:
4e. City, state, zip:
4f. Telephone r�o.:
4g. Fax no.:
4h. Email address:
5. AgenfilConsultant Informatian (if applicable)
5a. Name:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
�e. Telephone nc�.:
5f. Fax no.:
5g. Email address:
Page 2 af 1 �
PCN Form — Version 1.3 December 10, �4�8 Version

B. Project Informa#ion and Prior Praject History
1. Property Identification
1 a. Property identification no. (tax PiN or parcel ID):
1 b. Site coordinates in decimal de rees : L�titude: 36.14595 Longitude: - 81.50182
{ g )
(DD. DDDDDD) (-DC�. DaDDDD)
1 c. Property size: 0.1 acres
2. Surfiace Wa#ers
2�. �1ame of nearest body of water (stream, river, etc.) to E!k Creek
prc�posed project:
2b. Water Quality Cf�ssification of nearest receiving water: B, Traut, ORW
2c. River basin: Yadkin
3. Praject Description
3a. Describe the existing conditions an the site and the general land use in the vicinity of the projecfi at the time of this
application:
Scoured footer under the bridge
3b. List the total estimated acreage of all existing wefilands on the pr�perty:
0
3c. List the total estimated linear feet of all existing streams (inter�nitt�nt and perennial) on the praperty`
Bridge crosses the Elk Creek
3d. Explain the purpose of the propased project:
Stabilize the footers under the bridge to protect the structure
3e. Describe the overali project in detail, including the type of equipment to be used:
�ee atfiached cover letter
4. Jurisdictiona! Deterrninations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested ar obtained for this property /
project (including all prior phases) in the past? ���� � N"� [.� Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made? � Preliminary � Final
4c. If yes, who defineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): C�ther:
4d. If yes, list the dates of the Corps jurisdictional determinations or �tate determinations and attach documentation.
5. Praject History
5a. Have permits ar certificatians been requested or obtained for Yes �I
this ro'ect includin all rior hases in the ast? � �° ��n��°�n
p J C g� p ) p
5b. If yes, explain in detail according to "help file" instructions.
6. F�ture Project Plans
6a. Is this a phased project? � Yes � Na
6b. If yes, explain.
Page 3 of 10
P�N Form --Version �.3 December 1C�, 2��8 Ver�sion

C. Praposed Imp�cts Inventory ��
1. impacts Summary
1 a. Which sections were completed below for your project (check a11 that apply}: ��
❑ Wetiands � Streams - tributaries ❑ Buffer�
� CJpen Waters [� Pond Construction
2. Wetland Impacts
Ifi there are wetland impacts proposed Qn the site, then complete this questian for each wetiand area impacted.
2a. 2b. 2c. 2d. 2e. 2f. :.�._
Wetland impact Type of jurisdiction
number -- Type of impact Type of wetland For�sted (Corps - 4U4, 10 Area of impact
Perm�nent (P) or (if known) DV1/Q — non-404, other) (acres)
Tem orar T
❑ Y�s [� Corps .��.
W1 ❑ P[� T Nc� DW
❑ 0 Q
❑ Y�s [� Carps
W2 ❑ P❑ T N a DW
❑ ❑ C�
❑ Yes ❑ Corps �
W3 ❑ P�] T N a DW
� ❑ Q
❑ Y�s [.J Corps
W4 �P�T Nq DW
❑ (� Gt
❑ Y�s [� Corps
W5 (� P❑ T Na DW
� ❑ �
� Y�s (�] Corps
W� ❑ P[� T N4 DW
o a �
2g. Total wetland impacts
2h. Comments:
3. Stream I m pacts
If there are perennial or intermittent stream impacts (including tempor�ry impacts} propased on the site, then comple�e t�is
questinn for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Per�nnial Type of jurisdictic�n Average ��p�►��
number - (PER) or �Corps - 4n4, 1 U stream ler�gth
Permanent (P) or intermittent DWQ -- non-404, width (��►����'
TemporarY (T) (1�lT}? other) (feet) f�et)
Riprap bank � P�R � Corps
S1 (� P❑ T stabilization Elk Creek INT DW ��Q f��� �5
❑ � Q
G] P�R ❑ Carps
S2 �] P❑ T I NT DW
C� ❑ C�
S3 P T ❑ PER ❑ Corps
� ❑ � 1 NT DWQ
❑
C] PER ❑ Corps
S4 ❑ P�j T INT DW
❑ 0 Q
[,� P�R � Corps
S5 [� P❑ T INT DW
❑ � Q
❑ PER ❑ Corps
S6 C] P � T I NT DWQ
� �
3h. Total stream and tributary impacts 2�
3i. Comments:
Page 4 �f 1 �
PCN F�rm — Version 1,3 December 1�, 2UU8 Versian

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any ather apen wafier of
the U.S. then individually list a11 open water impacts below.
4a. 4b. 4c. 4d. 4e.
CJpen water Name ofi waterbody
impact number - (if applicable) Type of impa�t Waterbody type Area of imp�cfi (acres)
Permanenfi (P) ar
Tem orar T
01 � P❑ T Elk Creek Fill under/around foot�r stream p.p03
t)2 ❑P0T .��
(J3 ❑ P ❑ T �., �
..�..__..._��._.__ _.�___....
C74 �PC]T
4f. Tatal apen water impacts p.p�3
4g. Comments:
5. Pcand or Lake Canstruction
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland impacfs (acres) Stream Impacts (feet) Uplar�d
Pond In Proposed use or purpose �������
number of pond
Flooded Filled Exc�vated Flooded Filled Excav�ted Flc�oded
P1
P2
5f. Total
5g. �omments:
5h. Is a dam high hazard permit required?
❑ Yes ��10 !f yes, permit ID no:
5i. Expected pond surFace area (acres):
5j. �ize of pond watershed (acres):
5k. Method of construction:
6. Buffer lmpacts {for DWQ)
lf project will impact a profiected riparian buffer, then complete the chart below. If yes, then individu�lly list a11 buffer impacts
below. If an impacts require miti ation, then ou MUST fill out S�ction D of this form.
6a.
❑ Neuse ❑ Tar-Pamlico ❑ CJther:
Project is in which protected basin? ❑ C�tawba ❑ Rar�dleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number -- Reason Buffer Zone 1 imp�ct Zone 2 imp�ct
Perm�n�nt (P) or for Stream name mitigation (square feefi) (square feet)
Tem orar T im act re uired?
0 Y�s _
B1 ❑ P ❑ T N�
d
C� Yes
B2 [�P❑T N�
❑
❑ �es
63 ❑ P ❑ T ��
�
6h. Total buffer impacts
6i. Camments:
Page 5 af 10
PCN F�rm - Version 1.3 December 1�, 2008 Version

D. Impact Justificatior� and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize fih� proposed irnpacts in designing project.
Impacts will be the minimum needed to protect the footer
1 b. Specificaily describe measures taken fio avoid or minimi�e th� proposed impacts through construction techniques.
2. Compensafiory Mitigation fiar Impacts to Waters of the U.�. or Waters caf the State
2a. Does the project require Compensatory Mitigation for ❑ Y�s �(�o
impacts to Waters of the U.S. or Waters of the �tate?
2b. If yes, mitigation is rec�uired by (checl� all that apply): � C�WQ ❑ Cor'ps
� Mitigation bank
2c. If yes, which mitigat ion c�ption will be used for this
ro'ect? 0 Payment to in-lieu fee prog�am
p J
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. �lame of Mitigation Bank;
3b. Credits Purchased (attach receipt and letter} Type Quan#ity
3c. Comments:
4. Complete if Making a Payment ta In-lieu Fee Program
4a. Approval letter from in-lieu fee pragram is attached. 0 Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: C] w�rm ❑ 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. Complefie if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a descriptian of the prop�sed mitigation �lan.
Pagebof14
P�N Form -- Version 1.3 iDecember 1 Q, 20Q8 Ol�rsion

6. Buffer Mitigation (�tate Regulated Riparian Buffer Rules) — required by DWt�
6a. Will the project result in an impact within a protected riparian buffer th�t requires ❑ Yes �] No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone af the riparian bufiFer that requires mitigatian. Calcul�te the
amount of mitigation required.
6c. 6d. �e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet} (squ�re feet}
Zone 1 3(2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. lf buffer mitigation is required, discuss what type of mitigation is propased (e.g., payment ta private mitiga#ion b�nk,
permittee responsible riparian buffer restoration, payment intc� an approved in-lieu fe� fund).
6h. Comments:
Page 7 af 1 Q
P�N Farm — Version 1.3 December '!0, 2008 �/ersic�n

E. Stormwater Nlanagement and Diffuse Flow Plan (required by [�WQ}
1. Diffuse Flow Pian
1 a. Does the project include or is it adjacent to protected riparian buffers identified �re� Na
within one of the NC Ri arian Bu�fer Protection Rules? � �
p
1 b. If yes, #hen is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
Comments:
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project? N/A %
2b. Does this project require a Stormwater Management Plan? ❑ Yes � No
2c. If this project DOES NCJT require a�tormwater Management Plar�, explain why: Not increasing impervious surface area
2d. If this project DCJES require a Stormwater Management Plan, ther� provide a brief, narrative description ofi the pl�n:
❑ Cerkified �ocal Governmer�t
2e. Who will be responsible for the review of the �tormwater Management Plan? ❑ DWQ Stormwater Pragram
❑ �WQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? N/A
� Phase II
3b. Which of the follawin Iocall -im lemented stormwater mana em�nt ro rams ���W
g Y p 9 p� [� USMP
applY (check all that apply):
[�] Water Supply Watersh�d
[� Other.
3c. Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑ N�
atta�hed?
4, DWQ Stormwater Pro ram Review
Q Coastal counties
❑ HQW
4a. Which of the following state-implemented stormwater management programs apply �,pR�
(check all that apply):
� �ession Law 2��6-246
� C�ther.
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? 0 ��� � ��
5. DWQ 401 Unit S#ormwater Review
5a. Daes the Stormwater Management Plan meet the appropriate requirements? � Y�� �] �►o
5b. Have all of the 441 Unit submittal requirements been met? ❑ Yes [� No
Page 8 of 10
P�N Form -- Version 1.3 December 1�, 20�8 Version

F. Suppiemer�tary Information
1. Enviranmental Documentation (DWQ Requirement)
1 a. Does the project invalve an expenditure of public {federal/state/local) funds or the Y
use af ublic federai/state land? � e� ��°
p C )
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 (�j �lo
(Narth Caralina) Environmental Palicy Act {NEPA/SEPA)? �
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? {If sa, attach a copy of the NEPA ar �EPA final apprc�val
letter.) �j Yes ❑ No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wefiland Rules (15A NCAC ZH .0540), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or W�tland Stand�rds, ❑ Yes � No
ar Riparian Buffer Rules {15A N�AC 2B .Q200)?
2b. Is this an after-the-fact permit application? � Yes � No
2c, If you answered "yes" to one or both of the above questions, prc�vide an explanation of the �ioiation(s): Prampt Actian
Notice required immediate action. CC7E was notified of the pending a�tivity.
3. �umulative Impacts (DWQ Requirement)
3a. Will this project {based on past and reasonably anticipated fu�ure impacts) result ir� ��,e� ��Q
additional development, which cauld �mpact nearby downstre�m vvater quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact anafysis in accordan�e with the
most recent DWQ policy. If you answered "no,'' provide a short n�rrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition �non-discharge or �ischarge) c�f wastewater generated from
the proposed project, or available capacity of the subject facility.
N/A
Page 9 �f 10
P�N Form — Version 1.3 December 1�, 2+�08 Versic�n

5. Endangered Species and Designated Critical Habitat (Corps I�equiremeni}
5a. Will this project occur in or near an area with federaily protecfi�d species ar Y
h�bitat? ❑ �S � P�o
5b. Have you checked with the USFWS concerning Endangered �pecies Act Y��
im acts� � � �°
�
❑ Raleigh
5c. If yes, ind icate the USFWS Field Office you have cantacted.
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered �pecies or C�esignated �ritical
Nabit�t?
GIS and visual abservation
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential �sh habitat? ❑ Yes � I�o
6b. What data sources did you use to determine whether your site would impact Esser�tial Fish Habit�fi?
WRC will cammen#
7. Historic ar Prehistoric Cultural Resources {Corps Requir�ment)
7a. Will this project occur in or near an area that the sfiate, fiederal or tribal
governments have designated as having historic or cultural preservation ��,�� ��p
status (e.g., Natianal Histor�c 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 resaurces?
Activity is exempt from review.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 10a-year floodplain? �j Yes Q No
8b. If yes, explain how project meets FEMA requirements: Base fl�od elevations were not raised.
8c. Whafi source(s) did yau use to make the floodpfain determination? ncfloodmaps.com
�
J. �-Ieath �laughter �' �°'� 9/17/14
�
ApplicantlAgent's Printed Name Applican�lAgent's gn�ture C�a�e
(Agent's s�gnature is valid only if an auth '` zation letter from the applicant
is rovided.}
Page 10 �f 10
PCN F�rm -- Version '1.3 CJecember 1 C�, 2�0►8 Versian

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