20170167 Ver 1_courtesy_electronic_permit_application_20170207

STATE OF NORTH CAROLINA
DEPAR'TMENT QF TRANSPORTATIQN
ROY COoP�x
GOVERNOR
k'ebruary 6, 2017
Mr. Steve Kichefski
Asheville Regulatory Field Office
US Army Corp of Engineers
151 Patton Avenue
Asheville, NC 28801-5006
JAMES H. TYtOGDON, FII
SECFiETARY
SUBJECT: Bridge #8 Replacement on SR 2209 (Wesleyan Drive), Gaston County
Dear Mr. Kichefski:
The North Carolina Department of Transportation plans on replacing a deteriorating bridge on
SR2209 {Wesleyan Drive} in Gaston County. NCDOT proposes ta replace the existing 2 span
reinforced concre�e bridge with a 1 span cored slab bridge with 27 feet of associated xiprap
upstream for structure stabilization and for stormwater discharge points. A tempozary bypass
pumping system will be used to divert the stream around the construction site as needed. The
temporary shoring will extend into the pond to facilitate the construction of a retai.ning wall on
the pond edge (107 square feet of impacts). Due to the presence of a wetland area unmediately
upstteam of the bridge replacement proj ect, NCDOT proposes to maintain the water surface
elevation upstream of the impervious di�ce at 579 elevation (which is the elevation of the pond
daxn downstream of the bridge. All areas affected by temporary cafferdam system will be
restored to pre-project conditions.
A threatened/endaz�gered species survey on October 13, 2016 by personnel from Three Oaks
Engineering. The federally listed species for Gaston County (USFWS listed date Apri102,
2015} include the dwarf-flowered heartleaf (Hexastylis nanifl'ara}- T, Schweintiz's sunflower
(Helianthus schweinitzia�-E, Northern Long-Eared Bat (Myotis septentrionalis}- T, and Bog
turtle (Glyptemys muhlenbergii)- T/SA. Natural Heritage Program xecords document the nearest
dwarf-flowered heartleaf location appro�rimately 13 miles east of the proposed project area. The
heartleaf is usually found on dry to moist ravi.ne slopes (usually north facing and of the oak-
hickory piz�e forest type} and in boggy areas near springheads. No habitat is found in the project
area; however, minimal habitat does exist immediately upstreaxn and Hexastylis arifolia was
observed. The hexastylis species nor the forested habitat upstream will be impacted by this
project. Natural Herita.ge Program records document the nearest schweinitz'.s sunflower
location approxunate�y 2.6 miles north ofthe proposed project area. The heartleaf is usually
found on dry to moist ravi.ne slopes (usually north facing and of the oak-luckory-pine. The
sunflower is typically found along roadside rights of way, maintained power lines, and other
utility rights of way, edges of thickets and old pastures. There is no suitable habitat within the
project area and no spacies were observed. Natural Heritage Program records document the
neazest bog turtle location approximately 7 miles northwest of the proposed project area.

Bridge #8, McAdenville
February 6, 2017
Page 2
Bog turtle habitat consists of open, spri.ngfed wetlands with saturated muddy substrates. There is
no suitable wetland habitat in the project area and no species were observed. The bog turkle is
listed as T/SA (threatened due to similarity of appearance); therefore, does not require Section 7
consulta.tion. The Natural Heritage Program records document the neatest Northern Long Eared
Bat location approximately 38 miles northwest of the proposed project area. During suminer,
northern long-eared bats roost singly or in colonies underneath bark, in cavities, ar in crevices of
both live and dead trees. They may also roost in cooler places, like caves and mines. Tree species
may be used based on suitability to retai.n bark or provide cavities or crevices. It has also been
found, rarely, xoasting in structures like banas and sheds. Northern long-eared bats spend winter
3ubernating i.n humid caves and mines. The closest �isted undergroucnd mine, per NHI' database is
the Cathey Mine, 4.5 miles east of the project site. There are currently no knawn hibernaculum
or maternity roost trees in Division 12 counties for NLEB; therefore, the removal of the bridge
associated with this DOT project would be exempted from the incidental take under the 4(d)
Rule. I have attached a bat habitat assessment form for tiie bridge, as well as a copy of the NLEB
streaznlined consultation form. Per guidance from USFWS personnel, concurrence is granted by
citing the following website and a 30 day response period is waived.
h://www.fws. ov/asheville/htmis/ ro'ect review/NLEB in WNC.html
Bridge #8 is located on the south side of the McAdenville Historic District. �1 his project has
been reviewed and cleaa�ed by cultural resources staff (Internal Tracking # 11-09-0054). The
Assessment of Effects: Environmental commitment for design of bridge acceptable to town
sidewalk extension will not detract from historic district. {See attached information). The project
area is not located within %z mile of any critical watershed area, nor is SR 2209 a rural or urban
arterial; therefore, hazardous spill basins are not required. Enclosed is Yhe hazardous spill basin
checklist.
I have enclosed courtesy copies of pre-construction notification for a NW#3, plan sheets,
location naaps, and relevant project documentation. If you have any questions or concerns please
feel free to contact me at {704) 480-9044. Thank you for your time and considera�ion on this
matter.
Sincerely,
Mark Stafford, P.E.
Division Engi.neer
Twelfth Divis�on
BY: r
Trish Beam
Division 12 Environznental Supervisor
Enclosures

�ffice Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 pec 10 2008
Pre-Construction Natification Cl� Form
A. A licant Information
1, Processi�g
1a. Type(s} of approval soughtfrom the
Corps: � Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
7c. FEas the NWP or GP number been �erified by the Corps? ❑ Yes � No
1d. Type(sj of appro�al sought from the DWQ (check all that apply):
� 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Avthorization
1 e. Is this noiification solely for the record For the record only far DWQ 401 For the record only for Corps Permit:
because written appro�al is not required? Certification:
� Yes ❑ No � Yes ❑ No
9f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation � Y�S � f�o
of impacts? If so, attach the acoeptance letter from mitigation bank or in-lieu
fee program.
1 g. Is the project located in any of NC's twenty coastal cour�ties. If yes, answer 1 h ❑ Yes � No
helow.
1h. Is the project located within a NC DCM Area of En�ironmental Concern (AEC)? ❑ Yes � No
2. Project Information
2a. Name of project: Bridge #8, SR 2209 (Wesleyan Drive),
2b. Co�nty: Gaston
2c. Nearest municipalify 1 town: McAden�ille
2d. 5ubdi►rision name:
2e. NCDOT only, �.I.P. or state 17BP.12.R.13
project no:
3. �nrner fnformation
3a. Name(s) on Recorded Deed: NC DOT Right of Way
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. 5treet address:
3e. City, state, zip: ;
3f. Telephone no.: ,
3g. Fax no.: '
i
3h. Email address:
Page 1 of 11
PCN Form — Versian 1.3 December 10, 2008 Version

4. Applicant Information {if different from owner)
4a. Appficant is: ❑ Agent ❑ Other, specify:
4b. Name: Mark E. Stafford
4c. Business name N.C. Department af Transportation, DNision 12
(if applicable):
4d. Street address: 1710 Eask Marion Street
4e. City, state, zip: Shelby, NC 28151
4f. Telephane no.: 704-48d-9020
4g. Fax no.: 704-480-5401
4h. Email address: [e-mail]�
5. AgentlConsultant information (if applicable)
5a. Name: Trish Beam
5b. Business name �.C. Department of Transportation, Di�isian 12
(if applicable):
5c. Skreet address: 1710 East Marion Street
5d. City, state, zip: Shelby, NC 28151
5e. Telephone no.: 704-480-9044
5f. Fax no.: 704-480-5401
5g. Email address: [e-mail]�
Page 2 of 'f 1
PCN �'orm — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
7. Property Identificatlon
9a. Property ideniiflcatian no. (tax PIN or parcel ID): NA
1 b. Site coordinates (in decimal degrees]: Latitude: 35.2577 Longitude: - 89.0762
(DD.DDDDD�) (-Db.ddDDDD)
1 c. Properky size: 0.32 acres
2. Surtace Waters
2a. Name of nearest body of water (stream, ri�er, etc.) to Ut toSouth Fork Catawba Ri�er
proposed project:
2b. Water Qualiiy Classification of nearest receiving water: W5-V
2c. Ri�er basin: Catawba
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at ihe time of this
application:
Existing bridge consists of a reinforced concrete deck on I beams in an urban area.
3b. List the total estimated acreage of all existing wetlands on the property:
<0.10 acres
3c. Lisk the total estimated linear feet of all existing streams (intermittent and perenniaf) on the property:
100 feet
3d. Explain the purpose of the proposed project:
The purpose of the proposed work is to replace the deteriorating bridge for the safety of the tra�elling public.
3e. Describe the o�erall project in detaif, including the type of equipmenk to be used:
The North Carolina Depar#ment of Transportation requesks authorization to replace a deteriorating bridge on SR22U9
(Wesleyan Drirre) in Gaston County. NCDQT proposes to replace the sxisting 2 span reinforced concrete bridge with a 1
span cored slab bridge with 27 feet of associated riprap upstream for structure stabilizat9on and for stormwater discharge
points. A temporary bypass pumping system will be used to di�ert ihe stream around the canstruction site as needed.
The temporary shoring will extend into the pond to facilitate the construction of a rekaRning wall an the pond edge {107
square feet of impacts). Due to the prescence of a wetland area immediately upstream of the bridge replacment project,
NCDOT proposes to maintain the water surface efe�ation upsiream of the imper►iious dike at 579 ele�ation {which is the
ele�ation of tfi�e pond spillway ele�ation). All areas affected by temporary cofferdam system wifl be restored to pre-project
conditions.
7he Project will be constructed using #ypical heavy equipment (trackhoe, backhoe, etc.)
4. Jurisdictional Determinations
4a. Have jurisdictional wetfand or stream determinations by the
Corps or State been requested or obtained for this property 1
project (including all prior phases} in the past? ❑ Yes � No ❑ Unknown
Comments: Jurisdictiona! streamlwe�and determination
made by Di�isian 12 DEO.
4b. lf t�e Corps made the jurisdictional determination, what type
of determination was made? ❑ Preliminary ❑ Fina�
4c. ff yes, who delineated the jurisdictional areas? AgencylConsultant Company:
Name (if known): Other:
4d. If yes, list the dates af the Corps jurisdictional determinations or State determinations and attach documentation.
Page 3 of 11
PCN Form — Version 1.3 December 10, 2008 Versian

5. Project History
5a. Ha�e permits or certifications been requested or obtained for � Yes � No ❑ Unknown
this praject {including all prior phases) in the past?
5b. If yes, explair� in detai! according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ❑ Yes � No
6b. If yes, explain.
Page 4 of 11
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts I��entory
1. Irnpacts Summary
1 a. Which sections were completed belaw for your project (check all that apply):
❑ Wetlands � Streams - tributaries ❑ Buffers
❑ Qpen Waters � Pond Construetian
2. Wetland Impacts
If there are wetland impacts proposed on the site, then oomplete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type af jurisdiction
number — Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) bWQ — non�04, ot�er) (acres)
Tem ora T
W 1❑ P❑ T ❑ Yes ❑ Corps
❑ fVo ❑ QWa
W2 ❑ P 0 T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W3 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWGi
W4 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ QWQ
W5 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
WB ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on khe sike, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impaet Stream name Perennial Type of jurisdiction � A�erage Impact
number - (PER) or (Corps - 4�4, 10 stream length
Permanent (P) or intermittent DWQ -- non-404, width (linear
Temporary (7) {IN7)? other) (feet) feei)
Temporary Ut to South Fork � PER � Corps
51 ❑ P� T ShoringlBypass �p* 75
Pumping Cafawba Ri�er ❑ INT � DWQ
S2 � P❑ T REprap bank Ut to South Fork � PER � Corps 50 27
stabilization Catawba Ri�er ❑ INT � QWQ
S3 ❑ P 0 T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S4 ❑ P � 7 ❑ PER ❑ Corp5
❑ INT ❑ DWQ
S5 ❑ P❑ T ❑ PER ❑ Corps �
❑ INT ❑ DWQ '
SB ❑ P � T ❑ PER ❑ Corps i
❑ INT ❑ DWQ ,
3h Total stream and tributary impacts **g7
3i. Comments; *Pond backwater; "°27 feet of permanent impacts
Page 5 of 11
PCN Form — Version 1.3 December 10, 2008 Version

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts beiow.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number — (if applicable} Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Tem ora T
09 � P❑ T Retaining wall (interface between pond 0.002 (106 sq. ft)
road shoulder and exisitng pand)
02 ❑ P� T ' Temporary shoring pond 0.024 acres (1043 sq. ft)
03 ❑�❑T
04 ❑P❑T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pon� ID Proposed use or purpose (acres)
number of pand
Flooded Filled Excavated Flaoded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a ciam high hazard permit required?
❑ Yes ❑ No lf yes, permit ID no:
5i. Expected pond surFace area (acres):
5j. Size af pond watershed (acres):
5k. Methad of construction:
Pagebof11
PCN Form — Versian 1.3 December 10, 2�08 Version

6. 6uffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then com�lete tF�e chart below. If yes, then indi�idually list a11 buffer impacts
below. If an im acts re uire miti a6on, then ou MUST fill out Section D of this form.
Ba.
❑ Neusa ❑ Tar-Pamlico ❑ Other:
Project is in which protected basin? ❑ Catawba ❑ Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number —
Permanent (P) or
61 ❑P❑T
B2 ❑P❑T
B3 ❑ P❑T
Reason i Buffer
for Stream name � mitigatian
im act re uired7
❑ Yes
� ❑ No
� ❑ Yes
❑ No
❑ Yes
❑ No
6h. Total buffer impact�
6i. Comments:
D. Impact Justification and Mitigation
Zone 'E impact Zone 2 impact
(square feetj (square feet)
1. A�oidance anci MinErr�ization
ia. Specifically describe measures taken to avoid or minimize the proposed impacts in designing praject.
Replacement of bridge with bridge at same location. Remo�al of direct discharge paints to riprap ditchlines.
1 b. Specificaily describe measures taken to avoid or minimize the proposed impacts through canstruction techniques.
Minimization of impacts by maintaining a 579 water surFace elevation tiuring bypass pumping to prevent impacts ta upstream
wetland.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Doas the project require Compensatory Mitigation For
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply}:
2c. If yes, which mitigation aption will be used for this
project?
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased {attach receipt and letter)
❑ Yes � No
❑ DWQ ❑ Corps
❑ Mitigation bank
❑ Payment to in-lieu fee program
❑ Permittee Responsibfe Mitigation
Type
Quantity
Page 7 of 11
PCN Form — Version �.3 December 10, 200$ Version

3c. Comments:
4. Compfete if Making a Payment to In-lieu Fee Program
�4a. Approval letter from in-lieu fee program is attached. ❑ Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ❑ warm ❑ cool ❑cold
4d. Suffer mitigation requested (DWQ only): square feet
4e. Riparian we#land mitigation requssted: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigatjon requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permiitee responsible mitigation plan, provide a description of the praposed rrEitigation plan.
6. Buffer Mitigation (5tate Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a pratected ri�arian buffer that requires ❑ Yes � IVo
huffer mitigatian?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation reguired.
6c. 6d. 6�•
Zozle Reason for impact Total impact Multiplier Required mitigatEon
(square feet) (square feet)
Zone 1 3(2 for Catawba)
Zone 2 1.5
Bf. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type oi mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approveti in-lieu fee fund).
6h. Comments:
Page8of11
PCN Form — Version 1.3 December 10, 2008 Version

E. Stormwater Management and DifFuse Flow Plan (required by DWQ)
1, Dlffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified � Yes � No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? !f no, explain why.
Comments: ❑ Yes ❑ No
2. Stormwater Mana ement Plan
2a. What is the o�era[I percent imperviousness of this project? 0�o
2b. Does this project require a 5tormwater Management Plan? ❑ Yes � No
2c. If this project �OES NOT require a Stormwater Management Plan, explain why: Complies with NCDOT's indi►►idual
NPDES permit NCSQ00250.
2d. If this project DOES require a Stormwater Management Pfan, then provide a brief, narrative descriptian of the plan:
❑ Certified Local Go�ernment
2e. Who will be responsible for the re�iew of the Stormwater Management Plan? ❑ DWQ Stormwater Program
� DWQ 401 Unit
3. Certified Local Go�ernment Stormwater Review
3a. ln which local governmenYs jurisdiction is this project? NA
❑ Phase II
3b. Which of the following locally-implemented stormwater mar�agement programs � NSW
apply (check all that apply): ❑ USM�
❑ Water Supply Watershed
❑ Other:
3c. Has the appro�ed Stormwater Management Plan with proof of appro�al been ❑ Yes ❑ Na
attached?
4. DWQ Stormwater Pro ram Review
❑ Coastal counties
❑ HQW
4a, Which of the following state-implemented stormwater management programs apply � ORW
(check all that apply);
❑ 5ession Law 2006-246
� Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? � Yes ❑ Na
5. DWQ 401 Unit Stormwat�r Review
5a. boes the Stormwater Management Plan meet the a�propriate requirements? � Yes ❑ No
5b. Have alf of the 4Q1 Unit submittal requirements been met? � Yes ❑ No
Page 9 of 11
PCN Form — Version 1.3 December 10, 2008 Version

F. Suqplementary Information
1. En�ironmental Documentation (DWQ Requirement)
1 a. Does the project invof�e an expenditure of public (federallstatellocal} funds or the � Yes ❑ No
use of public (federal/state} land?
1 b. If you answered "yes" to the abo�e, does the project require preparation of an
environmental document pursuant to the requirements of the National or 5tate ❑ Yes � No
(North Carolina) Environmental Policy Act (NEPAISEPA)?
1c. if you answered "yes° to the abo�e, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA ftnal appro�al
letter.} ❑ Yes ❑ No
Comments:
2. Violatians (DWQ Requirement)
2a. Is the site in �iolation of DWQ Wetland Rules (�5A NCAC 2H .0500), Isolated
Wetlar�d Rules (15A NCAC 2H .1300), DWQ 5urtace Water or Wetland Standards, ❑ Yes � No
or Riparian Buffer Rules (15A NCAC 2B .Q200)?
2b. Is this an after-the-fact permit application? ❑ Yes � No
2c. If you answered "yes" to one or both of the abo►+e questions, provide an explanation of the �iolation{s):
3. Cumulati�e Impacts (DWQ RequiremenE]
3a. Will this project {based on past and reasonably anticipated future impacts) result in � Yes � Na
addikional de�elopment, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitati�e cumulati�e impact analysis in accorciance with the
most recent DWQ policy. If you answered "no," pro�ide a short narrati�e description.
The project is a minimum criteria project which has low potential for cumulati�elindirect impacts and will not result in
additional de�eiopment which could impact water quality.
4. Sewage Disposal (DWf� Requirement)
�a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject faciliry.
No wastewater generated fram project.
Page 10 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Criticaf Habitat (Corps Requirement]
�a. Will this project occur in or near an area with federally protected species or
habitat?
5b. Have you checked with the USFWS concerning Endangered 5pecies Act
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
� Yes ❑ No
� Yes ❑ No
❑ Raleigh
� Ashevi[le
5d. Wt�at data sources did you use to determine whether your site would irripact Endangered Species or Designated Critical
Habitat?
NC Naturaf Heritage Program database and on site survey.
B. Essential Fish HabiEat (Corps RequirementJ
6a. Will 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 Habitat?
No salt marshes, oyster reefs, or seagrass i�eds located in vicinity of project.
7. Histcric or Prehistoric Cultural Resources (Cor�s R�qu[rementa
7a. Will this project occur in ar near ar� area that khe state, federal or tribal
go�ernments have designated as having historic ar cultural preservation
status (e.g., Nativnal Historic Trust designation or properties significant in
North Carolina history and archaeology)?
>/ -
�� .
❑ No
7b. What data sources did you use to determine whether your site would impact historic or archeological resouroes?
Bridge #8 is located on the south side of the MaAden�ille Historic District. This project has been re�iewed and cleared by
cultural resources staff (Internal Tracking # 11-09-0054). Assessment o# Effects: Environrnenkal commitment for desing
vf bridge acceptabfe to town sidewalk extensEon will not detract �rom historic district.
8. Flooc! Yone Designation (Corps Requirement}
Sa. Will this project accur in a FEMA-designated 100-year floodplain? �� Yes ❑ No
8b. If yes, explain how project meets FEMA req�irements: NC�OT Hydraulics coordination with FEMA
8c. What source(s) did you use to make the floodplain determination? http:lliris.nc.go�l FEMA FIRM Map # 371035800J
'� //f, �C �c1S�� i �r `` a�� L/� � `! ` 1
r� vf' /�����'�
/ �
ApplicanU,�gent's Printed Name � ApplicantlAgent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant
is provided.l
Page 11 of 11
PCN Form — Version 1.3 December 10, 2008 Version

Bat Habitat Assessment Form
NCD�T Bridges
Observers: �L6✓ TIP or DOT pro�ert number: __ /7(3p /�. � l�
�ate/Time: Road Name/SR Number: ���r /J.-
County: �L•d�7ih Bridge Number: � �
Waterbody. �i� .Yd �t.'1�'l !�'�( � r'�,�
95 Surrounding habitat w/in 1 mi. Urban/commercial ��
of project footprint (approx)
Natural/rural
Any tree5 >3" DBH within project footprint? yes
Any shaggy trees or snags >5" DBH? yes
If yes to shag/snag, how much sunlight do they recei�e during the day?
If yes to shag/snag, list species of habitat trees >5" dbh
If snags >5"DBH are present in sunlit areas, pravide photos and lacation.
If large hollow trees are present, provide photos and location.
Presence of: in project footprint
Caves yes n
Abandoned mines yes no
If 'yes' to any of the above, provide photos, description, and location.
Suburban/residentiai �
Agricultu
no
1-3 hours
4-6 haurs 7+ hours
In �icinty {O.S mi)
yes �yes
Major water source in project footprint: ri�er strearr�/creek on lake
Suitable drinking habitat in the form of non-s#agnant, smooth or slack water? es no
Guard rails none concret timber
Deck type concr metal timber
Beam type none cancrete ee
End/back wall type ancr timber masonry
Creosote evidence
Shallow �ertical top sealed cre�ices (X. -13." wide, 4-12" deep)
Deep �ertical unsealed cre�ices (% -1%" wide, 12+" deepj
Max height of bridge dec�C above ground/water (ft): �L__
Night raost hahitat protected � no
Bridge alignment: N/S E/W NW/SE
Hours of sun exposure to bridge 0-1 2-3
Human disturbance under hridge high low n
Emergence count performed? (If yes, complete form next pagej yes
Evidence of bats using bird nests, if present? yes
E�idence of bats using bridge? (photas neededj yes
Bat sp�cies �resent:
Additior�a! Cammen#s:
metal
open grid
timber
yes
yes
yes
NE/SW
�o�
no
no
swamp
NCD07 Bat Bridge Habitat Assessment Form
Updated 3/18/15

Northe�-n Lon -Eared Bat 4 d RuIe Streamlined Consultation Form
Federal agencies should use this form for the optional streamlined consultation framework for the northern long-
eared bai (NLEB). This framework allows faderal agencies to re�y upon the U. S. Fish and Wildlife Service's
(LJS�'WS) Jatzuary 5, 2016, intra-Service Progratnmatic Biological Opinion (BO) on the fina14(d} rule for the
NLEB for section 7(a)(2} 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 rec{uired detPrniAtion; and (3) enabling
the USFWS to track effects and determine if reinitiation. of consultation is required per 50 CFR 402.1b.
This farm is not necessary if an agency detennines that a proposed action will have no effect to the NLEB or if
the USFWS �as concurred in writing with an agency's determination that a proposed action may affect, but is not
likely to adversely affec� the NLEB (i.e., the standard informal consultation pmcess). Actions that may cause
prohibited incidental take require separate formal consultation. Providi.ng this information does not address
section 7(a)(2) compliance for any other �isted species.
Information to Determine 4(d Rule Com liance;
1. Does the proj ect occur wholly outside of the WNS
2. Have you contacted the appropriate agenc}+2 to determine if your proj ect is near
known hibernacula ar maternit roost trees?
3. Could the project disturb hibernating NLEBs in a known hibernaculum?
4. Cauld the project alter the entrance or interiar environment of a known
hibernaculum?
5. Does the proj ect remove any trees within 0.25 miles of a known hibernaculum at
an time of year?
6. Would the project cut or desfixoy known occupied maternity roost trees, or any
other trees within a 150-foot radius from the maternity roost tree fram June 1
through July 31.
You are eligible to use this form if you have answered yes to question #1 or yes to question #2 and no to
questions 3, 4, 5 and 6. The remaindez of the form wil� be used by the USFWS to track our assumptions in the
BO.
Agency and Applicant� (Name, Email, Phone No.): NCDOT, Division 12, Trish Beam,
pdbeam _,ncdot.�, 704-480-9044
Project Name: Bridge #8 replace�ment, SR 2209 (Wesleyan Drive), Gaston County
Project Location (include coordinates if l�own):
Basic Project Description (provide narrative below or atta.ch additional information): Replacem�nt of
concrete bridge with new concrete bridge in same location.
1 http:l/www.fws.gov/midwest/endangeredlmammals/nleb/p�If/WNSZone.pdf
Z See http://www.fws.gov/midwestlendangered/mammalslnleb/nhisites,hhnl
3 If applicable - only needed for federal actions with applicants (e.g., for a permit, etc.) who are pariy to the consultation.

i r-r.m rv i►�r�
A�ency Determination:
By sig�ning this form, the action agency determines fhat 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 frorn submittal of this form, the action agency may
preswne that its determination is informed by the best available information and that its project
responsibilities under 7(a){2) v�rith respect to the NLEB are fulfilled through the USFWS January 5,
2416, Programtriatic BO. The action agency wi11 update this determination annually for multi-year
activities.
The action agency understands that the USFWS presumes that all activ�ities are implemented as
described herein. The action agency will promptly report any depa.rtures from the described activities to
the appropriate USFWS Field Office. The action agency will provide the appropriate USFWS Field
Qffice with the results of any surveys conducted for the NLEB. Involved parties will promptly notify the
appropriate USFWS Field �ffice upon finding a dead, injured, or sick NLEB.
�
Signa�ure:
Date Submitted: ! �� � " l
4 Any activity that temporarily or permanently removes suitable forested habitat, including, but not lixnited to, tree removal
from development, energy production and transmission, mining, agriculture, etc. (see page 48 of the BO).
5 If the project removes less than 10 trees and the acreage is un�rnown, report the acreage as less than 01 acre.
6 If the activity includes tree clearing in June and July, also include those acreage in April to October.

P1r�xt TraaimglVa (Jxfawa! Uae)
I1-09-0054
HISTORIC ARCHICTECTURE AND LANDSCAPES
ASSESSMENT OF EFFECTS FORM
This form only pertains to Historic Architecture and Iandscapes for this project. It
is not vatid for Archaeolo�ca! Resources. You must consult separatefy with the
Archaeoiogy Group.
PROJECT INFORMATiO�
PrajectNo: Str.# 350008 Caanty: Gaston
WBS Na: 17BP.12.R.13 Document i'CE
Fed Aid No: Funding: State �'ederal �
Federal Yes No Per�it NWP 3 or 14
Perm � : e(s):
Proiect Descrivtion:
Replace Bridge No. 8 on SR 2209 (Crameton Rd) over unnamed tributary to the Catawha River.
SUMMARY OF HISTORIC ARCHICTECTURE AND LANDSCAPES RE'VIEW
Description o review act�vities. resudts� and conclu�ions:
On Segtemher 26, 2411 rese�rch revealed that Gaston Cour�ty Bridge No. 8 abuts tha National
R�gister listed McAderaville Historic District. On October 18, 2a11 an NCDOT arc�itectural
historian conduct� a site �isit to docuFnent the vicinity. Gaston County Bridge No. 8 is located
on the s�uth boundary of the histor�c district. The closest property to the bridge is Pharr
Corpara�e Office Complex lacated at 100 Main St, z�ortheast af the �rridge. The complex consists
oi a systein of builciings both contribu�ing and non-contributing. The former mill ho�zse at 107
Poplar St is a non-contributing building in the historic district locatecl abaut 100 feet northwest
of the bridge. Sa�th of the bridge project are contemporary houses. Built in 1955, Gaston
Caunty Bridge No. 8 does not exemplify �ny distinctive engineaing or aes#hefic type and is not
eligibie for the National Regist�r of Historic Places.
ASSE$SMENT OF EFFECTS
P�roperty Name: McAdenville Historic District SYatus: NR
survey site No.: � GSO428
P1'N.•
Effec�s
❑ Na Effect � No Adverse Effect ❑ Adverse Effect
�xnlanc�on of.Eff'ecis Deei�ermi�ation:
'�Y►V�1rv�n C�rnnw�-�'�'`v�-�� �' a�.J�,S►� o � .
���o�(� O�-GGG���' '�p 'f-�r. ,�.�}'.ei�5�
�
uv� wdk' �t-'�b�� -�pr�.�` i+.,��v►zr o��Sivtic��
NLs1wlc Arc�Airaclr+re rtnd !lrxdserrpes 8hg'�lS ASSESSMENTfanae far Mixor Tin�rsparreflon PraJcels as Q�er1 jJ}ed Ui Nee 1007 Praprarx+nalfc.lgreenre��1.
Page 1 of 2

List ofEnvironmental_Commidnents:
� � � �'r`. �" lS
��'� ���'�
aar�.o� c.+� .
�j�ev�-� ex��ryr.
�� � �� � ��
YY`�
s J�,'� an l�o.-�n �
SUPPORT DOCUMENTATION
❑Map(s) ❑Previous Survey In,�o. ❑Photos ❑Corres�ondence �Design Plans
FINDING BY NCDOT AND STATE HISTORIC PRESERVATION OFFICE
Historic Architecture and Landscapes — ASSESSMENT OF EFFECT5
State Historic Preservation Office
�• 5 • !�
Date
FHWA, for the Divisian Administrator, or other Faderal Agency Date
FHWA intende to use SHPO's cancurrence as a basis of a"de minimis" finding For the %liowing praperties, �ursuant to
Section 4(�:
Hrs�wiC �4rckirMrrrre ruee f�rdaexFra SFFEcrsAssl�ss,uu&lvr�O,H,. for Mrkor rra,�sporkrrM,r Praluri rrs Qaalyfee r,►116e aoa� P„o�rrm„rarr� Rgreenrr�+�.
Page 2 of 2

Beam. Patricia
From: Reap, Shelby L
5ent: Monday, January 30, 2017 12:�47 �M
Ta: Rackley, Ste�en D; Beam, Patricia
Subject: RE: McAden�ille visualization #2
Hi Steve,
Renee says that we don't ne�d ta revisit eifiects since the town is or� baard with the single span.
Is the face af the cancrete score� or ot�erwise treated �r is it just plain concrete?
Thanks
Shelby
From: Rackley, 5teven D
Sent: Friday, ]anuary 27, 2017 �}:52 PM
To: Reap, Shelhy L; Beam, Patricia
Subject: McAden�ille �isualization #2
Ste�en Rackley
Bridge Praject Manager
Di�ision 12
NCDOT
704 480 9034 o#fice
�r���9�����d�t.���
1710 East Marion Street
Shelby, NC 28150
f.
�,'
; _
,�
%'N�thfng Compares�
Emai! correspondence to and from fhis address is su6ject to the
Norfh Caralina Pu6lic Records Law arrd may be disclased to third partres.
Email correspondence 4o a�d from ihis senrfer is subject to the N.C. Putrlic Records L.aw and may be disclosed to lhird parties.

NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division: �.12 County:.�aston Project ID:17BP.12.R.13
River Basin: Catawba Bridge No: 8
RoutE: SR 2209
Water uality Criteria:
Stream: Ut to South Fork Catawba River
Stream Crossing Blue Line On USGS
�RW
WSI
WS II,III OR N, Crossing Within O.Smi of W.S. Critical Area
Roadway Criteria:
Route Designation-
Arterial Urban
Arterial Rura,l
Additional Site Information:
Is a Hazardous Spill Basin Required?
Yes No
� r
r r
Yes No
� %�
Criteria Based Upon NCDOT "Best Management Practices far the
Protection of Surface Waters" (March, 1997).