20160806 Ver 1_Application_20160819

Carpenter,Kristi
From:Braquet, Stephanie
Sent:Friday, August 19, 2016 10:32 AM
To:[e-mail]; Wanucha, Dave
Cc:Crook, Mark; Carpenter,Kristi; Keen, Kiera T
Subject:Davidson County-Hill Myers Road
Attachments:permit application.pdf
Follow Up Flag:Follow up
Flag Status:Completed
Attached is the permit application for a pipe replacement project on Hill Myers Road in Davidson County.
If you have any questions or need further information, please feel free to contact me.
Thanks

Stephanie Braquet

Division 9 Environmental Specialist

North Carolina Department of Transportation

336 747 7800 office

[e-mail]

375 Silas Creek Parkway

Winston Salem, NC 27127-7167

Email correspondence to and from this address is subject to the

North Carolina Public Records Law and may be disclosed to third parties.

Email correspondence to and from this sender is subject to the N.C. Public Records Law and may be disclosed to third parties.
1

;;
Transportation
August 19, 2016
Mr.lohn Thomas
US Army Corps of Engineers
3331 Heritage Trade Dr.
Suite 105
Wake Forest, NC 27615
SUBJECT: Nationwide Permit #14
Replace pipe carrying Hamby Creek (Class C)
WBS Project No.: 9C.029111
Davidson County
Dear Mr. Thomas,
PAT McCRORY
Governar
NICHOLAS J. TENNYSON
se�rerary
We are requesting a Nationwide 14 permit for the pipe replacement on Hill Myers Road (SR 2026) over
Hamby Creek in Davidson County. I have attached a pre-construdion notification application, a
topography map with the project area circled, a vicinity map, construction sequence, construction plans,
and Northern Long-eared bat (NLEB) Streamlined Consultation form. Also included are "No Survey
Required" forms from NCDOT Cultural Resources: Historic Architecture and Archaeology. The project will
permanently impact 25 linear feet and temporarily impact 10 linear feet (dewatering) of Hamby Creek.
The existing pipe is 36" x 35'; the new pipe will be a 48" x 60', corrugated metal pipe (CMP), that will also
include a 5' x 5' junc[ion box. The site will be dewatered during construction in accordance with NCDOT's
Best Management Practices. All disturbed areas will be re-vegetated and the project will be released by
NCDOT's Roadside Field Operations Engineer/Technician once 80`Y vegetative cover is achieved.
The USFWS lists Schweiniti s sunflower (Helionthus schweinitziiJ as endangered and the Northern Long-
eared bat (NLEB- MyotisseptentrionolisJ as threatened in Davidson County. The Bald eagle (Halioeetus
leucocepha/usJ is protected under the Bald and Golden Eagle Protection Act (BGPA) in Davidson County.
There is no habitat for Schweiniti s sunflower or the Bald eagle in the project area; therefore, it was
determined that there will be 'no effect' on these species. There is habitat for the NLEB, however, since
there are no known maternity roost trees within 150-foot radius of the project area and there are no
known hibernaculum within 0.25 miles of the projed area, it was determined that the project may affect
but is not likely to adversely affect (MANLAA) the Northern Long-eared bat. See attached NLEB
Streamlined Consultation form.
If you have any questions, comments or need additional information after reviewing this material please
contact me at [phone]. Thank you for your cooperation in this matter.
Si cere ,
eph ie Braquet
Divisi Environmental Sp alist, NCDOT Division 9
�Nothing Compares�.._
StareofNonhCarolinz I Deparm�entofTrensportatlon I Division9—UMTNAtv�
375 Silas Creek Parkway I ti'�stou-Salem, NC 27127
[phone] T I (336)703-fi693 F

Transportation
Attachments: Application Package and plans
PAT McCRORY
Gavernor
NICHOLASJ.TENNYSON
Secre[ary
CC: Mr. Dave Wanucha, NCDEQ-DWR, Environmental Specialist- e-copy
Mr. Pat Ivey, P.E., NCDOT- Division 9- Division Engineer- cover letter
Mr. Mark Crook, P.E., NCDOT-Division 9-Davidson County Maintenance Engineer- e-copy
Mrs. Kiera Keen, NCDOT- Division 9 and 10, Roadside Environmental Technician- e-copy
�Nothing Compares'�� �._
Stare ofNortM1 Cazolina � Departruent of Transportatlon I Division 9- lJNII NAIvIE
375 Silu Creek Parkway I Winstou-Salem, NC 27127
[phone] 1' � (336)703fi693 F

o��F W ATp9OG
h T
� r
o �
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Pre-Construction Notification (PCN) Form
A. Applicant Information
7. Processing
1 a. Type(s) of approval saight from the Corps: OX Section 404 Pertnit ❑ Section 10 Permit
'I b. Specify Nationwide Permk (NWP) number: 14 or General Pertnit (GP) number. GC 3856
1 c. Has the NWP or GP number been verified by the Corps? ❑ Yes �X No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
� 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Pertnit
❑ 401 Water Quality CeRification — Express ❑ Riparian Buffer Authorization
1 e. Is this notifiption solely for the record For the record only for DWQ For the record onty for Corps Permit:
because written approval is not required? 401 Certification:
❑ Yes � No ❑ Yes � No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for
mitigation of impads? If so, attach the acceptance letter from mitigation bank � Yes � No
or in-lieu fee program.
tg. Is the projed located in any of NC's twenty coastal counties. If yes, answer t h � Yes � No
below.
1h. Is the project located within a NC DCM Area of Environmentai Concem (AEC)? ❑ Yes � No
2. Project Information
2a. Name of project: Pipe Replacement on SR 2026 Hill Myers Road
2b. County: Davidson
2c. Nearest municipality / town: Thomasville
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state project no: 9C.029111
3. Owner infortnation
3a. Name(s) on Recorded Deed: NCDOT Division 9
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if Mr. Pat Ivey, P.E.
applicable):
3d. Street address: 375 Silas Creek Pkwy
3e. City, state, zip: WinstonSalem, North Carolina 27127
3t Telephone no.: [phone]
3g. Fax no.: [phone]
3h. Emaii address: [e-mail]
Page 1 of 10
PCN Form — Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applirant is: ❑ Agent ❑X Other, speafy: Division Environmental Specialist
4b. Name: Stephanie Braquet
4c. Business name North Carolina Department of Transportation
(f applicable):
4d. SVeet address: 375 Silas Creek Pkwy
4e. Cily, state, zip: Winston-Salem, North Carolina 27127
4f. Telephone no.: [phone]
4g. Fax no.: [phone]
4h. Email address: [e-mail]
5. AgenUConsul�nt IMortnation (if applicable)
Sa. Name:
Sb. Business name
("rf applicable):
5c. Street address:
5d. Cily, state, zip:
5e. Telephone no.:
5f. Fau no.:
5g. Email address:
Page 2 of 10

B. Project Infortnation and Prior Project History
1. Properly IdenGfication
1a. Property identification no. (tax PIN or parcel ID):
1 b. Site �ordinates (in decimal degrees): Latitude: 35.8532 Longitude: -$0.1347
1c. Propertysize: 3 acres
2. SurFace Waters
2a. Name of nearest body of water to proposed project: Hamby Creek
2b. Water Quality Classification of nearest receiving water: C
2c. River basin: Yadkin/Pee-Dee
3. Project Description
3a. Describe the ewsting conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The ebsting site is an unpaved, gravei road that needs to be widened and paved. The existing 36" x 35' pipe will be replaced with a 48" x 60'
comigated metal pipe and a 5' x 5' junGion box. The existing land use in the area is residen6aVagricullural.
3b. List the total estimated acreage of all existing wetlands on the property: 0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 50
3d. Explain the purpose of the proposed project:
Project purpose is to replace an existing 36" x 35' pipe with a 48" x 60' corrugated metal pipe and juncfion box and also widen and paved the road.
3e. Describe the overall projed in detail, including the type of equipment to be used:
Standard construaion equipment will be used.
4. Jurisdictlonal Determinations
4a. Have jurisdictional wetland or stream determinaGons by the � Yes 0 No ❑ Unknown
Corps or State been requested or obtained for this property /
ro'ed includin all rior hases in the ast? CommeMs:
4b. If the Corps made the jurisdictional determination, what type � preliminary ❑ Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdictional detertninations or State determina6ons and akach documentation.
5. Project History
5a. Have permits or certificafions been requested or obtained for �y� � No ❑ Unknown
this project (inGuding all prior 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 � No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands � Streams—tributaries ❑ Buffers ❑ Open Waters ❑ Pond Construdion
2. WeUand Impacts
If there are wetland impacts proposed on the site, then complete this questfon for each wetland area impac[ed.
2a. 2b. 2c. 2d. 2e. 2f.
WeUand impact Type of impact Type ofwe8and Forested Type ofjurisdiction Area of
number Corps (404,10) or impact
Pertnanent (P) or DWQ (401, other) (acres)
Tem ora
W1 - Choose one Choose one YesMo -
y�/� - Choose one Choose one YeslNo -
W3 - Choose one Choose one YeslNo -
W4 - Choase one Choase one Yes1No -
WS - Choose one Choose one YeslNo -
� - 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 impacts) proposed on the site, then complete this
question inr all stream sites impaded.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial (PER) or Type of qverage Impact
number intermitterit (IN�? jurisdiction stream length
Permaner�t (P) or width (linear
TemPo��Y iT) (feet) feet)
S1 T FII Hamby Creek PER Corps 5 10
S2 P Culvert Hamby Creek PER Corps 5 25
S3 - Choase one _ _
S4 - Choose one - -
S5 - Choase one _ -
S6 - Choose one - -
3h. Tofal stream and tributary impacls 35
3i. Comments:
Page 4 of 10
PCN Form — Version 1.4 January 2009

4. Open Water Impacts
If there are proposed impads to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individual list alt o en water im acts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number (fi applicable) Type of impac! Waterbody Area of impact (acres)
Permanent (P) or type
Tem ora
01 - Choose one Choose
02 - Choose one Choose
03 - Choose one Choose
04 - Chooseone Choose
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If ond or lake consUudion ro d, then com lete the chart below.
Sa. 5b. Sc. Sd. 5e.
Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond (acres)
Flooded Filled Eucavated Flooded Filled Excavated
p1 Choose one
pQ Choose one
5f. Total•
Sg. Comments:
5h. Is a dam high hazard permit required? ❑ Yes � No If yes, permit ID no:
5i. F�cpeded pond surtace area (acres):
Sj. Size of pond watershed (acres):
Sk. Method of construction:
6. Buifer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an im cts re uire miti ation, then ou MUST fill out Secfion D of this form.
6a. Projed is in whidi protected basin? ❑ Neuse ❑ Tar-Pamlico � Catawba ❑ Randleman ❑ Other.
6b. 6c. 6d. Be. 6f. 6g.
Buffer Impact Reason for impad Stream name Buffer Zone 1 Zone 2
number— mitigation impact impact
Permanent (P) or required? (square (square
Tem ora T feet feet
B1 - YesMo
B2 - YesMo
B3 - YeslNo
B4 - Yes/No
65 - YeslNo
g6 - YeslNo
6h. Total Buffer Impacts:
6i. Comments:
Nage 5 or 1 U

D. Impact Justffication and Mitigation
7. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The current pipe is undersized and is being replaced with the appropriately sized cortugated meNal pipe. NCDOT is eMending the pipe 25' in length to
cortecliy align the stream with the channel on the outlet end.
1 b. Specficalty describe measures taken to avad or minimize the proposed impads ihrough construction techniques.
NCDOT BMPs for Sediment and Erosion CoMrol will be used.
2. Com ensato Miti ation for Im acfs to Waters of the U.S. or Waters of the State
2a. Dces the project requi2 Compensatory Mitigation for � Yes ❑X No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ❑ DWQ ❑ Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this ❑ payment to in-lieu fee program
project?
❑ Permittee Responsible Mitigation
3. Com lete if Usin a Miti ation Bank
3a. Name of Mitigation Bank:
Type: Choose one QuaMity:
3b. Credits Purchased (attach receipt and letter) Type: Choose one Quantity:
Type: Choose one Quantity:
3c. Comments:
4. Com lete if Makin a Pa ment to In-lieu Fee Pro ram
4a. Approval letter from in-lieu fee progrem is attached. ❑ Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream tempereture: Choose one
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitiga6on 2quested: acres
4f. Non-riparian wetland mitigation requested: aaes
4g. Coastal (tidal) wetland mi6gation requested: acres
4h. Comments:
5. Complete if Using a Pertnittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form — Version 1.4 January 2009

6. Buffer Mitigation (Sfate Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the projed result in an impact within a protected riparian buffer that requires � yes � No
buffer mitigation?
6b. If yes, then identiTy the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigaGon required.
6c. 6d. 6e.
Zone Reason for impact Total impact Mukiplier Required mitigation
(square feet) (square feet)
Zone 1 3(2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigafion is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer 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)
7. DiHuse Flow Plan
1a. Does the project include or is it adjacent to proteded riparian buffers identified � Yes 0 No
within one of the NC Ri arian Buffer Protection Rules?
1 b. If yes, then is a diTfuse flow plan included? If no, explain why.
� Yes � No
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project? o�
2b. Does this ro'ect re uire a Stormwater Mana ement Plan? ❑ Yes � No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
There will be no new impervious surface as a result of the project.
2d. If this project DOES require a Stormwffier Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stortnwater Management Plan? N�A
3. Certified Local Govemment Stormwater Review
3a. In which local ovemmerrt's'urisdidion is this ro'ecC?
❑ Phase II
3b. Which of the following locally-implemented stormwater management programs ❑ NSW
apply (check all that apply): ❑ USMP
� Water Supply Watershed
� Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ❑Yes ❑ No
attached?
4. DWQ Stormwater Pro ram Review
�Coastal counties
❑HQW
4a. Which of the following state-implemented stormwater management programs apply �ORW
(check ali that apply): ❑Session Law 2006-246
❑Other.
4b. Has the approved Stormwater Management Plan with proof of approval been � Yes ❑ No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? � Yes � No
Sb. Have all of the 401 Unit submittal requirements been met? � Yes ❑ No
Page 8 of 10
PCN Form — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project invoNe an expenditure of public (federal/state/local) funds or the 0 Yes ❑ No
use of public (federallstate) land?
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 � No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
tc. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of tlie NEPA or SEPA final approval
letter.) ❑ Yes ❑ No
Comments:
2. �olations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC ZH .1300), DWQ Surtace Water or Wetland Standards, ❑ Yes �X No
or Riparian Buffer Rules (15A NCAC 26 .0200)?
2b. Is this an after-the-fad permit appliption? ❑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 anticipated future impacts) result in �Yes �X No
additional development, which could impact nearby downstream water quality?
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 narra6ve description.
IndireG and cumulative impact anatysis is expec[ed for pipe replacement.
4. Sewage Disposal (DWQ Requirement)
4a. Clearty detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
�A the proposed project, or available capacity of the subject faality.
Page 9 of 10
PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will 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
impacts? ❑ Yes ❑X No
Sc. If yes, indicate the USFWS Field Office you have contaded. -
5d. What data sources did you use to determine whether your site would impact Endangered Speaes or Designated Critical
HabitaY?
North Carolina Naiural Heritage database
6. Essentlal Fish Habitat (Corps Requirement)
6a. Will this projed occur in or near an area designated as esseritial fish habitat? ❑ Yes � No
6b. What data sources did you use to determine whether your site would impad Essential Fish Habitat?
7. Historic or Prehistoric Cultural 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., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impad historic or archeological resources?
NCDOT Cutturai Resources Group reviewed the project for eifecLs. It was determined that there would be'no eifecP on Archaeology or Historic
Architecture. See attached "No Survey Required" fortns.
8. Flood Zone Designation (Corps Requirement)
8a. Will this projed oaur in a FEMA-designated 100-year floodplain? ❑ Yes X❑ No
8b. If yes, explain how project meets FEMA requirements:
N/A
8c. What source(s) did you use to make the floodplain determination?
FEMA Floodplain mapping
Stephanie Braquet, NCDOT Division 9 _ �
DES 08/19/2016
ApplicanUf�qenYs Printed Name plicant/ nPs ature Date
(AgenPs signature is valid on R n authorization
letter from the a Iicant is rovided.
Page 10 of 10

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Construction Sequence — Replace existing pipe: SR 2026 Hill Myers — Davidson County
1. Close Road
2. Install erosion control devices at each quadrent.
3. Block upstream flow with impervious structure. Use pump around method or pipe around and
dewater work area.
4. Remove road fill and existing pipe to Junction Box 5' X 5'.
5. Tear our old Box and move closer to the R/W and Set New Box
6. Excavate to sufficient depth to allow 1 foot (or 20 percent burial of pipe, if no bedrock is
encountered) and instail new pipe from box to end of pipe
7. Backfill pipe and place rip rap stabilization and vegetate.
8. Notify landscape department for final seeding and mulching.
9. Complete road grading and pave roadway.
30. Site conditions and weather may alter these plans.
11. Construction time at permitted location to be 1 week.
12. If there are any questions, call Phillip Callahan, TS II at Davidson Maintenance at 336-224-3200

SINGLE PIPE REPLACEMENT
PIPE SIZE: 4 " '
TYPE: CMP
WEST
STREAM BED
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
DIVISION 9
DAVIDSON COUNTY
SR 2026
Catch Basin
SURFACE
iirui,niu i' BELOW STREAM BED
OR
ON GRADE (1F BEDROCK IS PRESENT)
ARMOR @ INLET AND OUTLET WITH THE APPROPRIATE CLASS OF RIP RAP FOR EROSION PROTECTION.

CROSS SECTION
cL
�
RIGHT-OF-WAY
SHLDR , SHLDR
�, g, PAVEMENT WIDTH 0'-8'
I 8'
EP
FILL_
STATION =0+00
SXS'
-� 36' CP �OX
ATpF
EXISTING: 3S' -36" CP
PROPOSED: 60'- 48" CMP
COVER: MIN3'
DRAWN BY: TPC
PLAN VIEW
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DRAINAGE PERMIT STA. 0+00
COUNTY: DAVIDSON
SR 2026
NAME: HILL MYERS RD
DRAWING 1 OF 1

ili•r� �i� •� t,. �' i�.n i�i �I �i � ii
Federal agencies should use this form for the optional sireamlined consultation framework for the northem long-eazed
bat (NLEB). This framework allows federal agencies to rely upon the U.S. Fish and Wildlife Service's (USFWS)
January 5, 2016, intra-Service Programmatic Biological Opinion (BO) on the fma14(d) rule for the NLEB for section
7(ax2) compliance by: (1) notifying the USFWS that an action agency will use the streamlined framework; (2)
describing the project with sufficient detail to support the required determination; and (3) enabling the USFWS to track
effects and determine if reiniriation of consultation is required per 50 CFR 402.16.
This form is not necessary if an agency deterrnines that a proposed action will have no effect to the NLEB or if the
USFWS has concurred in writing with an agency's determinarion that a proposed action may affect, but is not likely to
adversely affect the NLEB (i.e., the standard informal consukation process). Actions that may cause prohibited
incidenffiI take requ've separate forntal consultation. Providing this information does not address section 7(a)(2)
compliance for any other listed species.
Informarion to Determine 4(d) Rule Compliance: YES NO
1. Does the project occur wholly ouuide of the WNS Zone'? ❑ x
2. Have you contacted the appropriate agencyZ to deterntine if your project is near X �
lmown hibernacula or maternity roost trees?
3. Could the project disturb hibernating NLEBs in a Imown hibernaculum? ❑ x
4. Could the project alter the entrance or interior environment of a lmown � X
hibernaculum?
5. Does the project remove any trees within 0.25 miles of a lmown hibemaculum at � X
any time of yeaz?
6. Would the project cut or destroy known occupied materniTy roost trees, or any
other trees within a 150-foot radius from the matemity roost iree from June 1 � x
throu Jul 31.
You are eligible to use this form if you have answered yes to question # 1 Q,Cyes to question #2 �to to questions 3,
4, 5 and 6. The remainder of the form will be used by the USFWS to track our assumptions in the BO.
Agency and AppGcant� (Name, Email, Phone No.): NCDOT Division
Stephanie Braquet, scbraauet(�a,ncdot.�ov, [phone]
Proiect Name: Davidson County-Hill Myers Road SR 2026
Project Location (include coordinaxes if known): 35.8532N -80.1347W
Basic Project Description (provide narrative below or aitach additional information): NCDOT will replace an
undersized pipe with a larger sized corrugated metal pipe (CMP), including a junction box. We will also
widen and pave the gravel road.
� http://www,fws.gov/midwest/endangered/mammals/nleb/pdf/WNSZone.pdf
z See http://www.fws.gov/midwesUendangered/mammalsJnleb/nhisites.htrnl
3 If applicable - only needed for federal actions with applicants (e.g., for a perntit, etc.) who aze party to the consultation.

General Project Information YES NO
A�encv Determination:
By signing tlus form, the action agency deternunes that this project may affect the NLEB, but that any
resulting incidental take of the NLEB is not prohibited by the fina14(d) rule.
If the USFWS does not respond within 30 days from submittal of ttris form, the action agency may presume
that its determination is informed by the best available information and that its project responsibilities under
7(a)(2) with respect to the NLEB are fulfilled through the USFWS January 5, 2016, Programmatic BO. The
action agency will update this determination annually for multi-year activities.
The action agency understauds that the USFWS presumes that a11 activities aze implemented as described
herein. The action agency will promptly report any departures from the described activities to the appropriate
USFWS Field Office. The action agency will provide the appropriate USFWS Field Office with the results of
any surveys conducted for the NLEB. Involved parties will promptly notify the appropriate USFWS Field
Office upon finding a dead, injured, or sick NLEB.
Signature:
Date Submitted: �'�Rl 2DtO
° My activity that temporarily or permanenUy removes suitable forested habitat, including, but not limited to,lree removal from
development, energy production and h�ansmission, mining, agticulture, etc. (see page 48 of the BO).
5 If the project removes less than 10 trees and the acreage is unknown, report the acreage as less than 0.1 acre.
6 If the activity includes tree clearing in June and July, also include those acreage in April to October.

Project No:
WBS No.:
Projrd Tru�king No. (Ldrrnrsf Urr)
16-07-0028
H[STORIC ARCHICTF,CTURE AND LANDSCAPES
NO SURVEY REQUIRED FORM
This form only pertains to Historic Architecture and Landscapes for this project. It
is not valid for Archaeological Resources. You must consult separately with the
Archaeology Group.
n/a
11
Federal I DQ Yes LJ No
INFORMATION
Co�uety
Doctrnterrt
Fundiug:
Perneit
Fedcral
14
Proiect Descriptios:
Grade, pave and add shoulders to SR 2026 (Hill Myers Road). Project length is 038 miles. The
proposed cross-section will be a two lane paved road with 40 feet of ditches, 18 feet width
roadway and five feet of paved shoulders. Thc proposed right-of-way is 60 feet.
SUMMARY OF
AND LANDSCAPF.S KEV[GW
Review of HPO quad maps, HPOweb GIS mapping, historic designations roster, and indexes
was conducted on 8/2/16. I3ased on this review, there are no existing NR, SL, DE, LD or SS
properties in the Arca of Potential Effects (APE), Davidson County tax records showed that there
1re threc propei4ies within the APE over the age of fifiy years old: all mid-twentieth century
houses that do not appear eligible for the National Register of Historic Places (NRI iP). Google
Strect View imagery showed two of tlte above houses 1nd they do not appear to possess the
architectural or historical significance needed to be considered potentially cligible for the
National Register of Historic Places (NRIIP). The APE is located east of Lexington and consists
of residential development. Therefore, because there are no potential historic resources within
the APP; thlt will be affected by the project, a survey is not required for this project.
W/:v t/re available inlormation urovirles R re/rnble bnsis for rensonnblv vrediclrnp //mt fhere
are no rrnidetrtired sisnircm�t lrrsloric nrchitectnrn! or lmrdscane resources iit 11re nroiect
aren:
I-IPO quad maps, HPOweb GIS mapping, Google Street View, Google tnaps �nd Davidson
County property records are considered valid tools for the purposes of determining the likclihood
of historic resources being present. A survey is not required for this project.
lGemrio Ardulrnnrc med /.�uWsmprx A'O SUNV%iY Rli{)U!l7liDfunn ja�.Vinor Dmrsp�rlmim�Ywjearv n� [Tralified in IGe 1007 Pmgmmmatic ARreamenr.
Pnge 1 of 3

SUPPORT DOCUMENTATION
�Map(s) ❑Previous Survey Info. �Photos �Corresponclence ❑Design Plans
FINllING BY NCDOT ARCHITF,CTURAL IIISTORIAN
Historic Architectw•e and Landscapes -- NO SURVEY REQUIRED
:�
Historian
/ r �,..
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flouse tivitliin APE, cn. 1935-/955, biterseclrar of Up/�er• Lnke Rond rnrd Hil7 �Llyer•s Roarl, Drrvitlso�i Cot�ei[y,
NC. Pholo vra Google Sh•ee/ �ieiv.
Hzslora drdiilrnnre and lan�bmpes,\'O SURI'!:'Y HEQIIlRIiD farni fur DLnor Tranapnnnllmr 1'rnJeers �n' Oi�/ feA /n /Le 700717ugranmmtle.l.¢rermenL
Pagc 2 of 3

Ho�ise ivithifi APE, cn. 19d5-1960, iirtersec[ron ajUpper Lake Rond rnxl Hil1 Myers Road, D�rvi�fsot� Counry,
NC. Photo vra Google Slreer View.
/lesmiie dreh/lrrnvr muf Lmuirrnpra A'O STOiI'/il' RFQU/RFD forn� fiu'.tlrnor %ronspormllmi Projeels' ne Q�ml�ad vn r6e I007 ProR�'mmm�lm dgrrnnmV.
Page 3 of 3

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Appraisal Card
Pagc 1 of 1
http:/h�nv�v.co.davidson.naus/tasnet/�lppraisalCard.aspx?idI'=6536548&Action=Auto 8/2/2016

P�ojecf Tracking No.:
16-07-0028
����;� NO ARCAAEOLOGICAL SURVEY REQUIRED FORM �,���''\
u� °�i. �a �� This form only pertains to ARCHAEOLOGICAL RESOURCES for this projecL It is not ��� ��
� a p�p; valid for Historic Architecture and Landscapes. You must consult separately with the �' ��.:'E,�
b��3% Historic Architecture and Landscapes Group. ��iZ:p�
PROJECT INFORMATION
Project No: SR 2026
,�: �.
F.A. No:
9C.029111
na
Pederal Permit Required?
Counry: Davidson
Document: Minimum Criteria
Funding: � State ❑ Federal
� Yes ❑ No PermitType: NWP#14
Projed Description:
The project calls for the improvement (grade, drain, base, pave, and widenin� of existing SR 2026 (Hill
Myers Road) in Davidson County. The archaeological Area of Potential Effects (APE) for the project is
defzned as an approximate .38-mile (611.55 m) long corridor starting at the intersection of Hill Myers
with SR 2024 (Upper Lake Road) and heading south towards the road's end. The corridor fodlows the
extsting road alignment and measures approximately 60 feet (18.29 m) wide extending 30 feet (9.14 m) on
either side of the centerline.
SUMMARY OF CULTURAL RESOURCES REVIEW
Brief description of rwiew activities, results of review, and conc[usions:
The Hill Myers Road improvement project is located southwest of T'homasville and northeast of
Lexington in the northeastem portion of Davidson Counry, North Carolina. The project area is plotted in
the northeast corner of the Lexington East USGS 7.5' topogaphic quadrangle (Figure 1).
A map review and site file search was conducted at the Office of State Archaeology (OSA) on August 1,
2016. No previously recorded archaeological sites have been identified within or adjacent to the APE, but
four sites (31DV111, 31DV112, 31DV115, and 31DV460) aze reported within a mile ofthe project.
According to the North Cazolina State Historic Preservation Office online data base (HPOWEB 2015),
there are no lmown historic architectural resources within the APE that may yield intact archaeological
deposits. Topographic maps, USDA soil survey maps, aerial photographs (NC One Map), and historic
maps (North Carolina maps website) were exarnined for information on environmental and culhual
variables that may have contributed to prehistoric or historic settlement within the project limits and to
assess the level of ground disturbance.
Hill Myers Road generally runs north-south along sloping ridges which are separated by a seasonal
drainage (Figure 2). Water from this drainage eventually empties into Hamby Creek, part of the Yadkin-
Pee Dee drainage basin. The surrounding azea mostly consists of open lawns with scattered groups of
trees. Although ground disturbance is minimal away from the road, the APE only mazginaily extends
onto these undisturbed properties. The gravel road bed and ditches occupy most of the APE. Soil erosion
is also likely high along the edge of the road due to a lack of cover.
According to the USDA soil survey report, the project area is composes of two soil series (see Figure 2).
Poindexter and Zion sandy loams (PaB; PaD) make of the majoriTy of the APE. This is a well drained
series with the PaB variant having a 2 to 8 percent slope and the PaD having 8 to 15 percent. The Enon
fine sandy loam is similaz and present at the northem and southern ends. It is well drained as well with a
slope of 2 to 8 percent. Although azchaeological sites are found along both of these series, the minimal
"No ARCHAEO/AGYSURVEYREQUIRED"form far MeAmeMedMiiwr7Ynnsponatlon ProJectsasQual�edin Ihe 2013 ProgrammoncAgreement.
1 of7

Project Tracking No.:
16-07-0028
eaRent of the APE onto undisturbed soils is not likely to yield significant results for this project.
A review of the site files show few archaeological reviews and/or invesfigauons carried out in the region.
These investigaflons have resulted in the identification of four archaeological sites (31DV l l I, 31DV112,
31DV115, and 31DV460) within the nearby vicinity. Most ofthe field investigations have been
conducted by The University ofNorth Cazolina at Chapel Hill during 1977. They recorded prehistoric
sites 31DV111, 31DV112, and 31DV115, but reported little information other than location. From this,
two oftheir sites, 31DVi 11 and 31DV115, aze situated on broad ridges similar to the current project
setting. However due to a lack of additional details, the sites' eligibility for the National Register has yet
to be assessed. The final site, 31 DV460, is a historic mill consisting of a dam and raceway. It was
recorded by archaeologist with NC DOT in 1990 and detemtined ineligible for the Narional Register. In
general, there aze probably more undocumented sites are in the region especially along the ridges, but
significant and intact sites are not likely to be encountered by the current project due to the limited scope
of work on undisturbed soils.
The historic map review also displays no significant historic feahues within the project area. The earliest
in which an approximate location could be determined is the circa 1868 P.E. Zink's Map of the Townships
ofDavfdson County (Figure 3). Major routes and waterways aze depicted but no other features are
present The 1890 Map ofDavidson Couniy by L. Johnson also illustrates no structures within the project
area, but a road with a similar alignment as Upper Lake Road is shown (Figure 4). T'he Calvin Miller
Map of Davidson County from 1910 is usual in that is does plot several household belonging to the
Hendrick's family near the approximate road location (Figure 5). However due to the scale and
schematic nature of this map, it is more than likely these household aze further to the east along SR 2027
(Tom Hendrick Road). LasUy, The Rurad Delivery Routes for Davidson County from ciroa 1910 shows
the cleazest picture of the region (Figure 6). Although no road or structures aze shown in the vicinity, Hill
Myers house is plot to the east near the current intersection of Tom Hendrick and Upper Lake. This is
weli away from the project area. Subsequent 20th cenhuy maps provide no further evidence for any
former historic feature within or near the project. As a result of this review, it is very unlikely for any
historic azchaeological resources to be encountered by this project.
BriefFaeplanatioe of why the available information provides a reliable basis for reasonably predictdng
that there are no unidentified historic properties in the APE:
The defined azchaeological APE for the proposed improvements to Hill Myers Road in Davidson County
is unlikely to impact intact and significant azchaeological deposits. This is primarily due to previous
ground disturbance caused by the existing road and the limited eactent of the APE onto undisturbed soils.
In addi6on, the historic maps show no significant former historic features within the APE. As long as
impacts to the subsurFace occur within the defined APE, no further archaeological work is recommended
for the pmposed improvements to Hill Myers Road. If work should afFect subsurface areas beyond the
defined APE, further azchaeological consultation might be necessary.
"No ARCfIAEOLOGY SURVEY REQUIRED" jorm for fhe AmemledMi'ror 7}onnportalion Projuts os Quolhed irc the 70/5 ProgrommaHc Agreement.
2of7

SUPPORT DOCUMENTATION
See attached: � Map(s) ❑ Previous Survey Info
❑ Photocopy ofCounty Survey Notes
FINDING BY NCDOT ARCHAEOLOGIST
NO ARCHAEOLOGYSURVEYREQUIRED
�
C. Damon Jones
NCDOT ARCHAEOLOGIST
Projec[TmcbngNo.:
16-07-0028
❑ Photos �Correspondence
Other: images of historic map
8/3/16
Date
"NoARCFGIEOlO(iYSURVEYREQU/RED"jorm for the AmerrdedM/'ror7Mnsportation Projecls osOuo(�ed /n Ihe 2015 ProgrammmicAgreement.
3 of 7

ProjeclTrockixg No.:
16-07-0028
Figure 1. Topographic Setting of the Project Area, Lexington East (1950; revised 1994) and Fair Grove
(1951; photorevised 1987), NC USGS 7'S Topographic Quadrangle.
"No ARCNAEOLOGYSU2VEYREQUIRED"farm for the Amended Minor Transporlalton Projects as Oua! fed in !he 20l5 ProgrammaticAgreement.
4of7

Project Trpcking No.:
16-07-0028
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Davidsror County Meters g
Figure 2. Aerial photograph of the APE showing development, contours, and soils within and near the
project area.
"NoARCHAEOLOGYSURVEY R6QUfRF.D"form for Ihe �Imended Minor Transporlafian Prajects as' Qval fed in lhe7015 P�ogrammaticAgreemen!
5of7

J� ; r�►�M
Projece Tracln"ng Na.:
16-�%-��28
��` � Project Area��'�` � j�. '�
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Figure 3. P.E. Zink's circa 1868 Map ofthe Townships ofDavidson Counry
location of the project azea.
wcu�orcc�
S/i`op
on.rar�r
I-� ('rr,.r ruc�
,l ����
the approximate
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Figure 4. L. Johnson's 1890 Map ofDavidson County showing the location of the project area.
"Na ARCHAEOLOGYSURVEY REQUfRED"fasm jor the AmeMed Minor Transpormlion Projec(s as Qvn(rfeed in ihe 20/S Programmatic Agreement.
6 of 7

Project Tracking No.:
16-07-0028
]ocation of the project area.
"No ARCHAEOl,OGYSURVEY REQl1lRED "form for lhe AmendedMinor Trmssportalion Projects os Ova/ fed in lhe 20/S ProgrammaticAgreemen(
7of7