20150765 Ver 1_Application_20150731

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1 SQl MAIL SERVICE CENTER, RALEIGH, N.C. 2�7�r9�—i SO1
PAT MCCRORY �ICI-�QL.A� 1. TvEI�TN�''�ON
GOVERNOR ACTING SECRETARY
� ' �'
l��Ir. Steve Kichefski
�E...��. S. Arn1� Carps of Engineers
Asheville Re�ulatory Field Office
l S 1 Patton Av�nue, Roc�m 20$
Asheville, NC 288Q 1-5006
Subj ect: Nationwide Perznit # 14
Replace Bridge �17 on SR 1109 �vith ABC
Ashe County, North Carolina
Project Number: 17BP.11.R.6� (I)Wt� Permit Fe�eo �240)
Dear Mr. I�.ichefski :
The North Carolina Departrnent of Transportation %s scheduled to repl�.c� �ridg� # l 7 i�
Ashe County with a new aluminum box cul�ert at the same locat���. �'h� ��isti�g
structure is a 23' long single span bridge with steel I-be�.ms. �A,.�1 c�f th� ��ma�nl�.g
components are timber. The proposed aluminum box culvert is � 9 e 5' �vid� �� l' lc��g.
The extra culvert Iength is needed du� to the skew of the crossir�g. �ulvert slope �v�ll b�
less than 1%. Three Baffles wi11 be inserted inta the culvert to maintai� c�az�n.�� ��dth
(inlet, outlet and one interic�r). Mitigatian will be provided through EE�' (� 1'j. �r� or�-
site detour is proposed on the west side �f the structur� (�ee attached pl�.r�s}. Strea�
impaGts are tabulated below.
Stream Impacts:
PHC)NE 919-707-2800 FAX [phone]

Ashe Bridge # 17 on SR 1109
July 3 �, ZQ 15
Th� rep�lacement of the exist�ng bridge with the propo�sed �.�v� �ulve��-t will r�c�uir�
temp�orary dewatering. A�. impervious sandb�a� dik.e �v�ll be constr�.�t�d up�s�trear�: �f t�.��
existing structure to create a small poa�l. �lea�. wa�er wi�l� � tempc�rarily be �u�n.��d� �.�ound �
ar pi�ed through the construction area ar�d �v111 be� discharg�d dow�.str��.n�.. �r�� d��y�
water lacated inside the construction area will b� purnped intt� a� silt b�ag if �e�es�a�y�.
CJnce the new structure is� in place, the imp�erviou� dike �vill b� r�mo��d �.�.d
preconstruction stre�ambed elevation� will be restor�d. �
Construction of this proj ect �vi1� require impact� tc� � w�.ters af the IJnited S�tat�s in the N���
F�.iver Basin. The existing br�dge crosses� M�ill ��reek (C1ass:� �, Trc��ut -�-)e This ��r�je�t
was reviewed for the presence of� threatened� and� endangered spe�ies b� our �at�.ral
Environment Section. Bog turtles are present in the� co�unt� but none wer� obser��d �.i t�i�
proj ect location. There will be some limited tr�e cutting at the p�roj ect lo�at��n, pr�mar�l�
due to the on-s�ite detour. The NLEB is lis�ed as a� protected sp�e�ies i� this c�unt� but r�c�
bat activit� �vas observed in the bridge. V�1�e ���vvould recommend a 1���'A..A. call �n �l�is
proj ect.
Cultural resource compliance work has been cc�mpleted. No archaeolc�gical res�urce� or
histaric properties fa11 v�ith the APE of this proj ect �see a��ached�.
The proj ect impacts are not s�gnificant in n�ture and should not r�mov� �r de�rade
existing vvater quality uses. Stormwater wi11 b� r�uted through gr�.ss or roc�. line�.
ditches, depending on t�.e ditch lir�e slope. Tot�.l l�:nd dlsturbance will be l�ss tha�. 1 ac��.
Pipe sizes used will be the minimu�rn necessary to �reate a safe roadw�.y. B� �.itl�1Z111� ti'1�
erosion control measures outllned in ihe ��$�.Ci'1121�I1tS �O ti11S �.�,1p�.1C�.�1��"1, C�.OW11S����.111
water quality standards will be protected. All appropriate B1ViPs �r�ll be us�d durir�g
construction.
By capv af this electronic letter, it is requested that Mrs. l��iarla �h�.mbers w�th the N�rth
�arolina Wildlife Resources �ammission cor�.m�nt directly t+o y�ou ca�cernir�g �h� 4Q4
Nationwide Permit application witl� a capy sent to me.
By copy of this electronic letter, �t is requested that the Divi�ion �f �V�.ter (��.ality�
401 /Wetlands Un1t, issue the apprc�priate per�nit for �onstructian of this prc�j �ct. It is
requested that a�ny comment� relat�d to th� 401 certification be for��.rd�d d�re�tly tc� ��
wit�. a cop� sent to the US Ar�ny Corps of Engineexs.
We wauld like to begin construction as soc�n as possible. If �'urtl��r ��.farmatior� �s
required, please let me knaw. Your early revievv and consideratic�r� w111 b� a��reclat�d.
Sincerely, ,�
��� �
A,
� �,
<�`
�-I�ath Slaughte�°
L��v�sio�. � 1 Envirc�r�mental Sup�rv�s��

Ashe Brid�,e # 17 on SR 1149
July 30, 2Q I S
Enclosures
cc: l��Iar1a Chambers, NCWRC
Amy Chapman� Division o� Water �ual�ty
Dave Wanucha, Division of Water Quality
1Vlarella Buncick, tJSFWS
IVlike Pettyj ohn, PE, D1V1S1t)Yl E11�l�le�r
Da�id Wayne, PE, Bridge Malntenance Engineer
Jami Csuynn, Division Bric�ge Pragram 11�Ianag�r
Heath Slaughter, Division Environmental (Jfficer
Neil Trivette, Roadside Environmental Field Operatior�s Eng�neer

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��- ;r�� Corps actior� I CJ no.
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Form Versior� 1.3 Dec 10 204�
Pre-Construct%on Notifica�ion Pt�I�T or
A. A lic�nt Information
1. Processing
1a. Type(s) ofi approval sought from the
(� Section 404 Permit ❑�ection 10 F'ermi�
Corps:
1 b. Speci€y Nationwide Permit (NWP} number: 14 or General Permit {�P} number:
1 c. Has the NWP or GP number been verified by the Gorps'? ❑ Yes � N�
1d. Type(s) af approvai sought from the DWQ (check all that appfy}:
(� �4Q1 Water Qual'rty Certification — Regular ❑ N�n-4t�4 Jurisdic�ionaf �eneral Perr�it
❑ 401 Water Quality Certification — Express ❑ Ripari�n Buffer Authorization
1 e. Is this notification solely for the record For the record only f�r DWQ 4�1 For the recc�rd only for Corps Perr�nit:
because writfien approvaf is not required? Certification:
❑ Yes � No [� Yes � N�
1 f. Is payment into a mitigation bank or in-lieu fee program propased for mitigation ���S ���
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program.
1 g. Is the praject located in any of NC's twenty coastal counties. If y+�s, answer 1 h ❑ Yes ��1a
below.
1h. Is the project located within a NC DCM Area of Environmental Car�cern (AEC)? Q Ye� � o
2. Project lnformation
2a. Name of project: Bridge #17 on SR 1109
2b. County: Ashe
2c. Nearest municipality / town: Mill Creek
2d. Subdivision name:
Ze. NCDOT only, T.I.P. or state 17BP.11.R.68
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT
3b. Deed Book and Page No.
3c. Responsible Party �for LLG i f
applicable):
3d. 5treet address: 801 Statesville Road
3e. City, state, zip: North Wilkesboro, NG 28659
3f. Telephane no.: 336-9�3-9242
3g. Fax no.: 336-667-4549
3h. Email address: hslaughter�C�ncdot.gov
Pag e 1 of 10
PCN F�rr� --1lersion 1.3 D�c�mber 1�, 2�08 �`ersian

4. Applicant Information (if different frorn owner) �
4a. Applicant is: ❑ Agent [� Other, specify:
4b. Name:
4c. Busines s name
(if applicable}:
4d. S#reet address:
4e. City, state, Zip:
4f. Telephone no.:
4g. Fax no..
4h. Email address:
5. Agent/Consultant lnformation (if applicable)
5a. Name:
5b. Business name
(if applicable):
5c. �treet address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Emai1 address:
Page 2 af 1 �
PCN F�rm -- i/ersian 1.3 Decemb�r 10, 24Q8 Versic�r�

B. Project Infarmation and Prior Project History
1. Property Identification
1 a. Property identi�cation no. (tax PIN or parcel ID):
1 b. Site coardinates {in decimal degrees): L�titude: 36.30653 Longitude: - 81.5�492
(DD.DDDC►DD) (-DD.DDDDDD}
1c. Property size: 0.5 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.� to M��� ��,���
proposed project:
2b. Water Quality Classification of nearest receiving water: C; Trout +
2c. River basin: Nevv
3. Project Description
3a. Describe the existing conditians on the site and the general land use in the vicinity of the pr�ject at the tirne of �his
application:
Substandard bridge #o be replaced in a rural area
3b. List the total estimated acreage of all existing wetlands on th� property:
4 acres
3c. �ist the total estimated Iinear feet of all existing streams (intermittent and perennial) on the property:
� 15� linear feet
3d. Explain the purpose af the proposed project:
Upgrade substandard stream crossing
3e. Describe the overall project in detail, including the type of equipm�nt to be used:
�ee attached cover letter.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all priar phases} in the past? ❑ Yes � No ❑ lJnk�own
Comments:
4be If the Corps made the jurisdictional determination, what type
of determination was made? ❑ Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Compan�:
Name (if known): (Jther:
4d. If yes, list the dates of the Corps jurisdictianal determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for � Yes � No ❑ lJnkno�n
this pro�ect (including all pr�or 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 � N�
6b. if yes, explain.
Page 3 c�f 1 a
PCN F�rm — Version 1.3 December 10, �008 �'ersiar�

C. Propased impacts Inventory ,
1. Impacts Summary
1 a. Which sections were completed below for your projeet (check all th�t apply):
❑ Wetlands � Streams - tributaries [] Buffers
� Open Waters ❑ Pond C:onstruction
2. Wetland impacts
If there are wetland impacts proposed on the site, then compiete this question for �ach wetland area impac#ed.
2a. 2b. 2c. 2d. 2�. 2f.
Wetland impact Type caf jurisdictiar�
number — Type of ir�npact Type of wetland Forested (Carps - 4�4, 14 �,re� of impact
Permanent (P) ar (if knawn) DWQ -- n�n-404�, �ther} {�cres)
Tem ora T
[] Yes � Corps
W'� ❑ P❑ T N ca �W
❑ ❑ C�
❑ Y�s ❑ Carps
W2 (� P❑ T No �W
❑ ❑ C�
❑ Yes ❑ Corps
W3 ❑ P❑ T N� p�
[� ❑ G2
[] Yes ❑ Cc�rps
W4 ❑P❑T ��
D ❑ Dw�
0 Y�s ❑ Corps
W5 CjP❑T Na
C) ❑ DWQ
❑ Y�s ❑ Corps
W� ❑ P(� T N� L�'1/V
� ❑ � Q
2g. Total wetland impacts
2h. Commer�ts:
3. Stream Impacts
If there are perennial or intermitt�;nt stream impacts (including tempor�ry impacts) proposed on the �ite, th�n cc�mplete thi�
question for all stream sites impacted.
3a. 3b. �c. 3d. 3e. 3f. 3g.
Stream impact Type of irnpact Stream name Per�nnial Type of jurisdiction Average Imp���
number - (PER} or (�orps - 404, 1 a stream �ength
Permanent (P) or intermittent pW� _ nQn_4pq., width (Iinear
Temporary (T) � (INT)? other} (feet) feet�
ABC, Deto�r Pipe, � PER � C�rps
S1 � P� T Dewaterin Mill Creek 1��. �W 11 227
9 ❑ � C�
❑ PER 0 Corp�
S2 0 P❑ 1' I Ni DW
❑ � �
S3 ❑P❑T
�] PER ❑ Corps
� I NT ❑ DWQ
[� P�R ❑ Corps
S4 D P❑ T I Ni DW
❑ ❑ C�
❑ PER C] Corps
S5 [,] P❑ T I NT DW
❑ 0 �
❑ P�R ❑ Corps
S6 ❑ P 0 T I N�" DW
a o �
3h. Total stream and tributary impacts ��7
3i. Comments: 81' ABC with headwalls, 146 temporary dewatering
Page 4 t�f 1 �
P�N F�rm -- Versior� 103 December 1�, 20�8 �fersic�n

4. C)pen Water impacts
If there are proposed impacts to lakes, ponds, estuaries, tributarie�, sounds, the Atlantic CJcean, or any other open water of
the U.S. then individually list ali open water impacts below.
4a. 4b. 4c. 4d. 4e.
C�pen water Name of waterbody
impact number - (if applicabie) Type of impa�t Waterbody �ype �r�a �f impac� (�cres)
Permanent (P) or
Tem orar T
01 � P❑T
Q2 0 P❑T
43 ❑P�T
Q4 ❑PC]T
4f. Total open water impacts
4g. Gomments:
5. Pond or Lake Gonstruction
If and or lake construction ro osed, then com lete the chart bel�w.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres} �tream Impacts (feet} lJpland
Pond I D Proposed use or pu rpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavafied Flooded
P1
P2
5f. Total
5g. Comments: N/A
5h. Is a dam high hazard permit required?
❑ Yes � I�o �f yes, perr�it IQ no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project wifl impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require miti ation, then ou MUST fill out Section D of this form.
6a.
[� N�use ❑ Tar-Pamlico ❑ (�ther:
Project is in which protected basin? ❑ Catawba ❑ Randleman
6b. 6G. 6d. 6e. 6f. 6g.
Buffer impact
r�umber - Reason Buffer Zone 'I irnp�ct Z�ne 2 impact
Permanent (P) or for Stream name mitigation (squ�re feet) (square �eefi�
Tem ora T im act re uired?
❑ Yes
B1 ❑ P ❑ T N�
❑
❑ Yes
B2 ❑P[.�T N�
0
B P T 0 Yes
� � ❑ No
0
6h. Total buffer i�apacts
6i. Comments:
PageSof14
P�N F�rm - Versiar� 1.3 C7ecember 10, 2008 �/ersia►n

D. impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifica#ly describe measures taken to avoid or minimize th� proposed impacts in designing proj�ct.
The culvert length is the minimum needed to improve �afety at this lo�ation. Floodplains and baffles will be constructed to
maintain channel width.
1 b. Speci�cally describe measures taken to avoid or minimi�e the proposed impa�ts through �onstru�tion techni�ues.
RII appropriate BMPs will be used during construction
2. Compensatory Mitigation for Impacts to Waters of the U��. or Waters of the �tat�
2a. Does the project require Compensatory Mitigation for � Yes ❑ iVo
impacts to Waters of the U.S. or Waters af the State?
2b. If yes, mitigation is required by (check all that apply�: ❑�WQ ��o�'ps
[� Mitigation bank
2c. If yes, which mitigat ion aption will be used for this Pa ment to in-iieu fee ro ram
ro'ect?' � Y p g
p 1
[� Permittee Responsible Mitigati�n
3. Complete if Using a Mitigation Bank
3a. Name af Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) iype Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-Iieu fee program is attached. � Y�s
4b. Stream mitigation requested: 81 lin�ar feet
4c. If using stream mitigation, sfiream 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 descripiion of the praposed mitigation plan.
Page 6 �f 1 Q
P�N Form -- �fersion 1.3 Decernber 10, 2�n8 '�ersic�n

6. Buffer Mitigation (State Regulated Riparian Buffer Rules} �- required by DWQ
6a. UVill the project resuit in an impact within a protected riparian buffer that requires ❑�es � IVo
buffer mitigation?
�b. if yes, then identify the square feet of impact to each zone of the riparian bufifer th�t requires mit�gatior�. �alculafie the
amount of mitigation required.
6c. 6d. 6e.
�one Reason for impact Tatai impact iViultiplier Required mitig�tion
(square feet) ��quare fee��
Zone 1 3 (2 for �atawba)
�ane 2 1.5
6f. Tatal buffer mi�igation required.
6g. If buffer mitigation is required, discuss what type of mitigatic�n is proposed {e.g., payment to priv�te mifiigation k�anik,
permittee responsible riparian buffer restoration, payment into an �ppraved in-Iieu fee fund).
6h. Comments:
F'age 7 of 10
PCN Form — Version 1.3 December 1 �, 20a8 �ersion

E. Stormwater Management and Diffuse Flow Plan (required by DWQ�
1. Diffuse Flo�nr Plan
1 a. Does the project include or is it adjacent to protected riparian buff�rs identifi�d �.��� ���
within one of the NC Riparian Bu�fer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
Cornments.
C� �es ❑ ��
2. Stormwater Mana ement Plan
2a. What is the overail percent imperviousness of this project? °/a
2b. Does this project require a Stormwater Management Plan? � Y�s � 6��
2c. If thi� project DOES NOT require a Stormwater Management Plan, explain why: Ciisturbing Iess than 1 acre
2d. If this project DQES require a Stormwater Management Plan, ther� provide a brief, narrative d+�scriptian af the plar�:
❑ Certified Local Government
2e. Who will be responsible for the review of the Starmwater Management Plan? 0 DWQ Stormwater �'rogram
❑ DiNQ 401 IJni�
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
�] Phase II
3b. VVhi _ ❑ NSi/V
ch of the following locally implemented sto�mwater management programs �����
apply (check all that apply):
� Wafier Supply UVatersl�ed
D other:
3c. Has the approved Stormwater Management Plan with proof af approval beer� ��'es ��lo
attached?
4. DWQ Stormwater Pro ram Review
❑ Coas�al co�nties
❑ H ��
4a. Which of the following state-implemented stormwater manag�ment programs apply ❑�R�
(check all that apply):
�j Session Law 200�-246
❑ (Jther:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? [� Yes ❑ IVa
5. DWQ 401 Unit 5tormwater Review
5a. Daes the Stormwater Management Plan meet the appropriat� requirements? ���� ���
5b. Have all af the 401 Unit submittal requirements been met'? � Y�� ���
Page $ of 10
PCN F�rm — Version 1.3 December 14, 2D08 i/ersion

F� Supplementary In�ormation
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the ��e� � IVa
use of public (federal/state) Iand?
1b. If you answered "yes" to the above, does the project require preparation of an
environmentai document pursuant to the requirements of the �lati�nal or State ❑ Yes � fVa
{Narth Caralina) Environmental Policy Act (NEP,A/SEPA)�
1 c. If you answered "yes" to the abave, has the document review been finalized by th�
State Clearing House? (If so, attach a capy of the NEPA or �EPA finai approval
letter.) ❑ Yes ❑ f�o
Camments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of �WQ Wetland Rules (15A NCAC 2H .0500}, Isolated
Wetland Rules {15A NCAC 2H .130�}, DWQ 5urface Water or Wetland Standards, ❑ l�es � I�o
or Riparian Buffer Rules (15A NGAC 26 .0200}?
2b. Is this an after-the-fact permit application? ❑ Yes ��lo
2c. If you answered "yes" to one or both of the above questians, provide an explanation of the violatian(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Wili this pra�ect (based on past and reasonably �nticipated fu�ure impacfis} resuit in �.��� ��
additional develapment, which could impact nearb downstre�m water ualit ? �
Y q Y
3b. If you answered "yes" to the above, submit a qualitative or qu�ntitative cumulative imp�ct analysis i� �ccardan�e with the
mast recent DWQ policy. If you answered "no," provide a short narrative description.
4, Sewage Disposal (DWQ Requirement)
4a. Clearly detail t�e ultimate treatment methods and disposition {non-discharge or disch�rge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
N/A
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P�N F�rm -- Version 1.3 December 10, 2Q0� �'ersior�

5. Endangered Species and Designated Critical Habitat (Corps Ftequiremeni)
5a. Will this project occur in ar near an area with federaily protected species or ���� ���
habitat?
5b. Have you checked with the USFWS concerning Endangered �pecies Ac� Y�� �
impacts? � a
[� Raleigh
5c. If yes, ind icate the IJSFW� Field Office yau have contacted.
� Asheville
5d. What data saurces did you use to determine whether your site wauld impact Endangered Species or De�ignated Critic�l
Habitat?
GIS and visual observation. USFWS will be capied on this p�rmit application. Requesting that the C�rp� caordir�ate vvith
USFWS regarding the NLEB.
G. Essential Fish Habitat {Corps Requirement)
6a. Will this project occur in or near an area designated as essential fi�h habitat� ❑ Yes ��la
6b. What data sources did you use to determine whether your site would impact Essential Fish I�abitat�
WRC will comment
7. Historic or Prehistoric Cultural Resources (Corps Requfrement�
7a. Will this project occur in ar near an area that the state, federal or triba{
governments have designated as having historic or cultural preservatian [� Yes � No
status (e.g., National Historic Trust designation ar 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"?
Project was reviewed by the aHE. See attached forms.
8. Flaad Zone Designatian (Corps Requirement)
8a. Will this project occur in a FEMA-designated 10Q-year floodplain? ❑ Yes � No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s} did you use to make the floodplain determination? FRI�
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J. �Ieath �laughter 7/3�115
.
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Applicant/Agent's Printed Name pplican�/Agent's Sig ure ���e
(Agent's s ature is ualid only if an authoriZ t' n letter from the applicant
is provided.)
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