20140937 Ver 1_Application_20140904

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STATE OF �TORTH CA.ROLINA
DEPARTMENT OF TRANSPORTATION
PAT McCRORY P. O. Box 25201, Ralelgh, �I� 2�G11-5�02
C.,TOVERNC�R PHONE: [phone]
� eptember �, 2 014
Mr. 1�.ndy Williams
tT. S. Army Corps of Engineers
Ralelgh R.egulatory Field Office
3 3 31 �erltage Trade Drive, Suite 1 U5
Wa�.� Forest, NC �75 87
TC��I� TAT�,
SECR.ETARY
Subj ect; Natianwide Permit #3
Replace Pipe #02-216� an SR 1424
Alleghany County, North �arolina
Project Number: 11B.2Q0311 (No DWQ Permxt F'ee Rec��.ired)
Dear Mr. Williams:
The North Carolina Department of Transportation is scheduled to replace Pi�e #�2-216� with a
new pipe at the same location. The existing pipe is in poor conditian and needs ta be replaced.
We will add 10 feet to the nevv pipe length to iznprove shoulder raom. No�e t�.at the riprap
shown at the outlet end on the plan sketch is a riprap collar around the to� of the pipe. The�re will
be some rock on the outlet bank but not the streambed. Stream irr�pacts are tabulated below:
Stream Impacts:
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Permanent FillfR.i�ara�a Impacts = 30 fee�
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m
'�'�atal �'roie�t I�n�acts = "�0 �"��t
The replacement of the existing pipe with the praposed new pipe wx11 requ:
de�vatering. An lmper�lous sandbag dike tiv�ll be constructed approximately 2� fe�
the existing structure to create a small pool. �lean water w111 temporarily be pum�
construction area and vvi11 be discharged downstre�.m. Any dirty water locat
constructian area will be pumped into a silt bag if �ecessary. Once the new struct�
the impervious dike will be removed and preconstructic�n streambed elevations will
P. O. $oX 250, N. WIL�ESS0�0, NC 28659
PHO�E [phone] Fax [phone]
re tempora.ry
t upstream of
�d around the
�d ins�de th�
re is in place,
be restcared.

Mr. Andy Willlams
Pipe #02-� 166 on SR 1424
Page 2
September 4, 2014
Construction of this proj ect will require impacts to waters of the IJ�.�ted States in tl�� i�ew �.iver
Basin. The existing pipe carries a LTT to the Li�tl� R1ver (Class: C). This project �as rev��wed
for the presence of threaten�d and endangered spec��s on September 3, 2014. The s�.bject project
will have no effect on any federally listed endan�ered plant or animal speci�es. �Iistoric
compliance work wi11 be scheduled and co�curren�e with the State �istorlc Preservatior� C�f� c�
will be obtained if required.
The project irnpacts are not significant in nature and should not alter the best usage for this
stream. All �.ppropriate BMPs will be used dur�r�g ccanstruction. Attached is a Preconstructlon
Notificatian Form, plan sheets, a marked count� map and a m.arked topography map.
By capy of this letter, it is requested that Mrs. Marla Chambers, Mountain Region' Coordinator,
w�th the North �arolina Wildlife Resources Commissi�n comment directly to you ccance�rning the
404 Nationwide Permit application with � copy sent to me.
We would like to begin construction as soon as poss�ble. If further in�'ormation is required,
pleas� let me know. �our early review and consid�ratlon will be appreciated.
Sincerely,
I-�eath S laught�
Divisior� Envi�r
Enclosur�s
cc: Marla �hambers, Western Piedmont Regian Coord�nator, NCWRC
Amy Chapman, Di�ision of Water Quality
Mike Pettyj ohn, PE, Division Engineer
David Wayne, PE, Division Bridge Maintenance Engineer
�-Ieath Slaughter, Division Enviror�mental t�ffi�er
Zack Souther, Roadside Environmental Field tJperations Technician

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Office Use CJnly:
Corps action I D no.
DWQ project no.
Form Version 1.3 Dec� 10 2C►Q8
� Pre-Construetion Not�ification �(�'�N� ��'o�-�m
A. A� � lica��n� Information
1. Processing
1a. Type{s} of approval sought from the
Car s: � Section 404 F'err�it � Sectior� 1 � Permit
p
1 b. �pecify Nationwide Permit (NWP) number: 3 or Gener�l P�rmit {GP} number:
1 c. Has the NWP or GP number been verified by the Gorps?
Q Yes �j No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
❑ 401 Water Quality Certification — Regular ❑ Nan-404 Jurisdictional General Permifi
0 4�1 Wafier Quality Certificatian — Express ❑ Ripari�n Buffer Authorization
1 e. Is this notification solely for the record Far the record only for DWQ 401 For the record on�y far Corps Permit:
because written approval is not required? Certification:
� Yes C] No ❑ Yes
1 f. Is payment into a mitigation bank or in-lieu fee program propased for mitigation � Yes
of impacts? If so, attach the acceptance letter from mitigation bar�k or in-lieu
fee program.
1 g. Is the project located in any of NC's twenty coas�al counties. If y�s, answer 1 h [� Yes
below.
1 h. Is the project located within a NC DCM Area of Enviranmental Concern (AEC)? ❑ Yes
2. Project Information
2a. Name of project: Replace Pipe #02-2166 on SR '1424
2b. County: Alleghany
2c. Nearest municipality / town: Sparta
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state 11 B.200311
project nc�:
3. CJwner Information
3a. Name(s} on Recorded Deed: NGDOT
3b. Deed Boak and Page No.
3c. Responsible Party (for LLC i f
applicable}:
3d, Street address: 801 Statesville Road
3e. City, state, zip: North Wilkesboro, NC 286�9
3f. Telephone no.. 336-903-9242
3g. Fax no.: 336-667-4549
3h. Email address: hslaughterC�ncdot.gov
� ��
❑ No
� No
� No
Page 1 c�f 10
P�N Form — Version 1.3 De�ember 1�, 2�d8 Version

Page 2 �f 1 a
� P�N Form -- Version 1.3 Dec�mber 1C
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B. Project infiormation and Priar Project Histary
1. Properfiy Identification
1 a. Property identification no. (tax PIN or parcei 1D):
1 b. Site coordinates {in decimal degrees);
1c. Praperty size:
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project:
2b. Water Quality Classification of nearest receiving water:
2c. River basin:
Latitude: 36.51789
(DD. DDDDDD)
0.1 acres
Ui to Little River
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3. Project Descriptic�n
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the fiime af this
applicatian: �
Subsfiandard pip�e to be replaced ir� a rural area
3b. List the total estimated acreage of all existing wetlands on the property:
0 acres
3c. �ist the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
1�0 linear feet
3d. Exp�ain the purpose of the proposed project:
Upgrade substandard stream crossing
3e. Describe the overall project in detail, including the type of equipm�nt to be used:
See attached cover letter.
4. Jurisdictional Determinatians
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this properky /
pro'ect (including all priar phases} in the past? ❑ Yes � No � tJnknovrrn
1
Comments:
4b. If the Corps made the jurisdictional determination, what type
� ❑ Preliminary [� Final
of determination was made .
4c. If yes, wha delineated the jurisdictional areas? AgencylConsultant Company:
Name (if known): CJther.
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and �ttach dc�cumer�tation.
5. Project History
5a. Have permits or certifications been requested or obtained for � Yes
this project {including all prior phases) in the past?
5b. If yes, explain in det�il according to "help file" instructions.
6. Future Project Pfans
6a. Is this a phased project?
6b. If yes, explain.
❑ Yes
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P�ge 3 c�f 14
PCN Form -- Versian 1.3 December 1 C�, 2408 Versi�n

C. Proposed Impacts Inventory
1. Impacts Summary
� a. Which sections were completed below far your project (check all that apply):
❑ Wetlands j� Streams - tributaries ❑ Buffer�
[] Open Waters ❑ Pond Constructian
2. Wetland Impacts
If there are wetland irnpacts proposed on the site, then complete this question for each wetland area im�acted.
2a. 2b. 2c. 2d. 2e. � 2�. �
Wetland impact Type of jurisdictian ;
number -- Type afi impact Type of wetland Forested (Corps - 404, 1� Are� of impact
Permanent (P) or (if known) D1/VQ -- non-404, otner) (acr�s}
Temporarv (T)
W1 ❑P❑T
W2 ❑POT
W3 ❑P❑T
W4 ❑POT
W5 C�P❑T
W6 [� P ❑ T
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2g. Total wetland impacts
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 a11 stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. �g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average �►�p���
number - {PER) or {Corps - 444, �� stre�m I�r�gth
Permanent (P) or intermittent DWQ — non-404, width (��n���'
Temporary CT) (I�1T)� other) " (�e��) ��"���
=''" '• • ••.•:
�- . - .
S2 ❑P❑T
S 3 ❑ P � ,-
S4 C]P❑T
S5 ❑P[.�T
S6 �]P�T
UT to Little River � PER
[� 1 NT
❑ PER
❑ INT
� P�R
❑ ! fVT
0 PER
❑ I �VT
❑ PER
❑ I fVT
❑ PER
[] I IVT
3h. Total stream and tributary irnpacts
3i. Commenfis: 1� pipe, 20 riprap & 4� linear feefi of dewatering
� Corps
(�I Dw'�
❑ Corps
❑ DWQ
[� Corps
❑ DWQ
❑ C o rp s �.�.._..�,...._
C] DWQ
❑ Corps
❑ DWQ
[� Corps
❑ DV1IQ
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Page 4 af 10
PGN Form -- Version 1.3 December 1�, 2��8 Ver�ion
m

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, esfivaries, tributaries, saunds, the Atlantic Ocean, or any;c�ther open water af
the U.S. then individually Iist all open water impacts below.
4a. 4b. 4c. 4d. 4e. ��� �
CJpen water Name of waterbody
impact number — {if applicable) Type of impact Waterbody type �rea of impact (�cres)
Permanent (P) ar
Tem orar T
O1 ❑PC�T
02 ❑P❑T ��
CJ3 ❑P❑T �
04 [�P�T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construc�ion
If ond or lake construction ro osed, then com lete the chart below.
5a 5b. 5c. 5d. 5e. �
Wefiland Impacts {acres) Stream Impacts (feet} Uplar�d
Pond 1D Proposed use or purpase {������
number of pond
Flooded Filied Excavated Flooded Filled Gxcavated Flooded
P1
P2
�f. Total
5g. Comments: NIA
5h. Is a dam high hazard permit required?
❑ Yes ��lo If yes, permit ID no:
5i. Expected pond surface area {acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then cornplete the chart below. If yes, then individually list all bufifer imp�cts
belaw. If an impacts require miti ation, then ou MUST fill out Section D of this form.
6a. N�use Tar-Pamlico C�ther:
❑ ❑ �
Project is in which protected basin? ❑ C�tawba ❑ Randlem�r�
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number -- Reason Buffer Zone 1 impact Zane 2 irnpact
Permanent (P) or for Stream name mitig�tion (square feet) (square feet)
Tem or�ar T im act r� uired?
❑ Yes ��
61 ❑POT N� .
❑
❑ Yes
62 ❑ P ❑ T N�
0
❑ Yes
B3 ❑ P ❑ T No
❑
6h. Totai buffer impacts
6i. Comments:
P�ge 5 of 1 �
P�N Form — Version 1.3 December 1�, 2008 Version

D. impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avaid or minimiz� th� proposed impacts in designing p�oject. ��
The pipe length is the minimum needed to improve safety afi this focation.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts thrr�ugh const�uction techniques.
Ali appropriate BMPs will be used during construction
2. Compensatory Mitigation fc�r Impacts to Waters of the U.�. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impact� to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (chec� all that apply):
2c. If yes, which mitigat ion option will be used for th�s
praject?
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
3c. Comments:
►1 -� ■ •
■ � +� I►:1 • •
� �itigation bank
� Payment to in-lieu fee program
❑ Permittee Responsible Mitigation
Type � Quantity
4. Gomplete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee pragram is attached. [� Y�s
4b. 5tream mitigation requested: 10 linear feet
4c. lf using stream mitigation, stream temperature: ❑ warm ❑ cool
4d. Buffer mitigation requested (DWQ anly): 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
P.�1. • •
5a. If using a permittee responsible mitigation plan, provide a description of the praposed mitigation pl�n.
Page 6 of 1 C�
PCN Form -- Version 1.3 �ec�mber 1 C�, 20C�8 Version

6. Buffer Mitigation (State Regulated Riparian Bufifer Rul�s) — required by DWQ
6a. Will the project result in an impact within a protected ripari�n buffer that requires ❑ Yes � No
buffer mitigation?
6b. If yes, then identify �he square feet of impact to each zone of the riparian buffer that requires mitiga�ion. Calcul�te the
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet} (sq�are �eet)
Zane 1 3(2 for Catawba)
Zone 2 1.5
6f. Total buffer mi�iga�ion required:
6g. If buffer mitigation is required, discuss what type of mitigation is praposed (e.g., p�yment to private mitigation bank,
pern�ittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page "7 af � 0
P�N Form — Version �.3 December 1C�, 2008 Ver�ion

E. Stormwater Management and Diffuse F1ow P�an (required by C�WQ)
1. Diffiuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified
within one af the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a dif�use flow plan included? If no, exp(ain why.
Comments:
❑ Yes � �1�
❑ Yes [� i� c�
2. 5tormwater Mana ement Plan
2a. V1lhat is the overall percent imperviousness �f this praject? °lo
2b. Does this project require a Stormwater Management Plan? ❑ Yes ��Io
2c. If this project aOES N(JT require a Stormwater Management Plar�, explain why: no change in impervious surface area
2d. 1f this project DaES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Wha wil! be responsible for the review af the Stormwater Management Plan?
3. Certified Local Governmenfi Stormwater Review
3a. In which local government's jurisdiction is this project'?
3b. Which of the fallowing locally-implemented stormwater management programs
apply (check all that apply):
3c. Nas the approved Stormwater Management Plan with proof of approval been
attached?
4. DWQ Stormwater Proqram Review
� Certified �ocal Government
❑ DWQ Stormw�ter Program
❑ DWQ 4n1 Unifi
❑ Phase ! i
(� N SW
❑ USMP
❑ Wa�er Supply Watershed
� C�ther:
[� Yes [� No
❑ Coastal �ounties
❑ HQW
4a. Which of the following state-implemented stormwater managemer�t programs apply 0 p��
(check all that app1Y): ❑ Ses�ior� Law 2006-246
❑ C�ther:
4b. Has the approved Stormwater Management Plan with proof of approval been
afitached?
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 ❑ Na
�J Yes � N o
Page8af1�
PCN Form -- Versian 1.3 December 1 U, 2008 Version

F. Supplementary Information
1. Envirc�nrnental Documentation (DWQ Requiremer�t)
1 a. Does the project invoive an expenditure of public (federal/statelloc�l) funds or the
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require prep�ration of an
environrnentai document pursuant to the requirements of the National or State
(Nc�rth Carolina} Enviranmental Poiicy Act (NEPAI�EPA)?
� Yes � Nc�
❑ Yes I� No
1 c. If you answe red "yes" to the above, has the document review been finalized by the
State Clearing Nause? (if so, attach a copy of the NEPA or SEPA finai approv�l
letter.} ❑ ��S
Comments:
2. Violations {DWQ Requirement}
2a. Is the site in vialation of DWQ Wetland RuLes (15A NCAC 2H .�5�0), Isolated
Wetland Rules (15A NCAC ZN .1300}, DWQ SurFace Water or Wetland Standards, ❑ Yes
ar Riparian Buffer Rules (15A NCAC 2B .02�0)?
2b. Is fihis an after-the-fact permit application?
� .
►1 •
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2c. If you answered "yes" to one or both of the above questions, provide an explanation of the viola�ior�{s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anfiicipated future impacts) result in � Yes � No
a d d i t i o n a l d e v e l o p m e n t, w h i c h c o u l d i m p a c t n e a r b y d o w n s t r e a m w a t e r q u a l i t y?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accardance with the
most recent C1WQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generafied from
the proposed praject, or available capacity of the subject facility.
N/A
Page�of10
PCN Form -- Version 1.3 December iC�, �C�08 Versi�n

5. Endangered Sp�cies and Designated Critical Habitat (Corps Requirem+�nt)
5a. Wili this projecfi occur in or near an area with federally protected species or
habitat?
5b. Have you checked with the USFWS cancerning Endangered Species Act
impacts?
5c. If yes, ind ic�te the USFWS Field Office you have cr�ntacfied.
❑ Y�s � No
� Yes � No
❑ Raleigh
� Ashevilie
5d. What data sources did yau use to determine whether your site would impact Endangered Species �r Designated Critical
Habitat?
GIS and visual observation
6. Essential Fish Habitat (Corps Requirement}
6a. Wiil 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 would impact Essential Fish Habi
WRC will comment
►/ •
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project accur in or 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 �i nificant in � �
C 9, g p p g
North Caralina histor}r and archaeology)'?
7b. What data sources did you use to determine whether your sit� would impact historic or archeologic�l resources?
Activity is exempt due to small scale within existing right-of-way.
8. Flood Zone Designation (Corps Requirement)
8a. Will this praject occur in a FEMA-designated 100-year floodplain? ❑ Yes j�j �lo
8b. If yes, explain how project meets FEMA requirements:
8c. VVhat source(s} did you use to make the floodplain determination? ncfloodmaps
J. �Ieath Slaughter
Applicant/Agent's Printed Name
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ApplicantlAgent's �i���� ture
{Agent's si ature is valid anly if an authori on letter from the applicant
is provided.)
9/4/ 14
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PCN Form — Version 1.3 December 1 C�, 2�08 Versior�