20170260 Ver 1_permit_application_package_20170306

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATIQN
ROY COOPER
GovE�oR
March 6, 2017
Mr. Steve Kichefslci
Asheville Regulatory Field OfFice
U5 Army Corp of Engineers
151 Patton Avenue
Asheville, NC 28801-5006
7AMES H. TROGDON, III
SECRETARY
SUBJECT: Bridge #275 Replacement and Pipe Replacement on SR 1603 (Carpenter Hoyle
Road), Cleveland County
Dear Mr. Kichefslri:
The North Carolina Department of Transportation (NCDOT) requests authorization to replace an
existing 121-foot long X 20.2-foot wide timber deck bridge wit� a 130-ft long x 27-ft wide
concrete bridge on SR 1603 (Carpenter Hayle Raad) in Cleveland County. NCDOT proposes to
place a total of 4 feet of rip rap for a deck drain pad under Bridge #275. The existing riprap
under Bridge #275 {see attached photos} will remain and no additional riprap bank stabilizatian
is recommenc��d. NCDOT also request authorization to replace an existing 5$-foot long 42"
CMP with a 100-foot long 60" RCP in the same vicinity. NCDOT proposes to place a total of
20-feet of riprag upstream and downstream of the new pipe for stabilization. There will be 40
feet of temporary impacts to Knob Creek associated wi� the existing bridge end bent removal
and 224 feeE of temporary dewatering impacts associated with the culvert replaceffient. A lined
diversion channel from the unnamed tributary to the main channel of Knob Creek is planned to
manage stream flaw during the culvert replacement. Areas affected by temporary impacts will be
restored ta pre-project conditions. The scope of work will result in a total of 66 feet of
permanent impacts and 264 feet of teznporary impacts.to Knob Cre�k and an unnamed trihutary
to Knob Creek which is classified as C1ass C waters by the Division of Water Resources.
The Division 12 Environmental Office conducted a threatenedlendangered species survey on
September 29, 2015 for Bridge #275 and surrounding areas. The federally listed species fox
Cleveland County (USFWS listed date Apri102, 2015} is the dwarf-flowered heartleaf
(H�xastylas nanaflora) and the Nort.lzern Long-Eared Bat {Myotis septentraonadis}. Natural
Heritage Program records document the nearest dwarf-flowered heartleaf location appro�mately
2.5 miles north of the proposed project area. The heartleaf is usually found on dry to moist ravine
slopes (usually north facing and of the oak-hickory-pine forest type) and in boggy areas near
springheads. There did not appear to be suitable habitat within the proposed project area and no
species were observed. No impact on this species is anticipaied. The Natural Heritage Program
records document the nearest Northern Long Eared Bat location approximateiy 6.1 miles north of

Bridge #275, Caxpenter Hoyle Road
March 6, 2017
Page 2
the proposed project area. During surnmer, northern long-eared bats roost singly or in colonies-
underneath bark, in cavities, or in crevices of both live and dead trees. They may also roost in
cooler places, like caves and rnines. Tree species may be used based on suitability ta retain bark
or provide cavities or crevices. It has also been found, rarely, roosting in structures like barns and
sheds. Northern long-eared bats spend winter hibernating in humid caves and mines. The closest
listed underground mine, per NHP database is the Bumgarner Mine, 1.5 miles west of tlae proj ect
site. There are currez�tly no kuown hibemaculum or maternity roost trees in Division 12 counties
far NLEB; therefore, the bridge replacement, pipe replacement and any minor tree clearing
associated with this DOT project would be exempted from the incidental take under the 4(d)
Rule. I have attached a copy of the NLEB streamlined consultation form. Per guidat�ce from
USFWS personnel, concurrence is granted by citing the following website and a 30 day response
periad is waived. http://www.fws.�ovlasheville/h�xnls/project_review/NLEB_in WNC.html
There are no si.tes listed on the National Register of Historic Places are lacated in t,�ze vicinity of
the project nor did there appear to be any eligible structures. The project bas been reviewed by
NCDOT's cultural resources staff (NCDOT Cultural Resaurces Review — Intennal Tracking No.
15-10-0005}.
The project area is not located within'/z mile of any critical watershed area. SR 1603 is not a
rural or urban arterial; therefore, hazardous spill �asins are not required. Enclosed is the
hazardous spill basin checklist.
I have enclosed a pre-construction gotification for a NW#3, plan sheets, and location maps
relative to the proj ect.
Project information for the 4Q1 Automated Payment Procedure is as follows:
• Work order number: 150464-55120005-17BP.12.R.43-3372
• TIP#: NA
• Project Category: $240.00 Fee
If you have any questions or concerns please feel free to contact me at (7U4) 480-9044. "I'hank you for
your time and consideration on this matter.
Sincerely,
Mark Stafford, P.E.
Division Engineer
Twelfth Division
BY: 1 `�
��
�!j'r�----r
Trish Beam
Division 12 Environmental Supervisor
Enclosures

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Offioe Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 bec 10 2008
Pre-Construchon Notif�cation PC Form
A, A licant Information
1. Processing
1a. Type(s) of approval sought from the
Corps: � Section 404 Permit ❑ Section 10 Permit
1 b. Specify Natianwide Permit (NWP) num�ier: 3 or General Permi# (GP) number:
1c. Has t�e NWP or GP number been �erified by the Corps? ❑ Yes � IVo
� 1d. Type(s} of approval sought from the DWQ (check a!! that apply};
� 401 Water Quality Certification — Regu4ar ❑ Non-404 Jurisdictionaf General Permit
❑ 401 Water Quali#y Certification — Ex�ress ❑ Ri�arian Buffer Authorization
1 e. ls this noti#ication soiely for the record For the record only �or DWQ 401 For the record only for Corps Permit:
because written ap�roval is nat required? Certification:
❑ Yes � �!a • � Yes ❑ No
�f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation � yes No
of impacts? If so, attach the acceptance letter from m9tigation bank or in-lieu �
fee program.
1 g. Is the project located in any of IVC's twer�ty coastaf counties. If yes, answe� 1 h ❑ Yes � No
below.
1 h. Is the project located within a NC DCM Area of En�ironmentai Concern (AEC)? ❑ Yes � No
2. Project Information
2a. Name of project: Bridge #275, 5R 16a3 (Carpenter Hoyle Road}
2b. County: Cleveland
2c. Nearest municipality 1 town: �awndale
2d. Subdi�ision name:
2e. NCDOT only, T.I.P. or state 17BP.'l2.R.43
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: �C DOT Right of Way
3b. Deed Book and Page No.
3c. Responsible Party (�or LLC if
applicable):
3d. Sireet address:
3e. City, state, zip:
3f. 7elephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 11
PCN Fo�m — Version 1.3 December 10, 2008 Version

4. Applicant Information tif difFerent from owner)
4a. Appiicant is: ❑ Ager�t 0 Other, specify:
4b. I�ame: Mark Stafford
4c. Business name N.C. Department of 7ransportation, Di�iSion 12
(if applicable):
4d. Street address: 1710 East Marian Street
4e. Cify, state, zip: Shelby, NC 28151
�4f. Telep�one no.: 704-480-9020
4g. Fax no.: 704�80-5401
4h. Email address: [e-mail]�
5. AgentlConsultant Infvrmation (if applicable)
5a. Name: Trish Beam
5b. Business name N.C. DeparEment of Transportaiion, Division 12
{if applicable):
5c. Street address: 971U East Marion Street
5d. City, state, zip: Shelby, NC 28951
5e. Telephone no.: 704-480-9D44
5f. Fax na.: 704-480-54U1
5g. Email address: [e-mail]�
Page 2 of 11
PCN Form — Version 1.3 December 1 Q, 2008 Version

B. Project Information and Prior Project History
1. Prvperty Identification
7a. Property identification na. (tax PIN or parcel ID): NA
1 b. Site coordinates (in decimal degrees): Latitude: 35.52208 �ongitude: - 81,53586
(DD.aDDDaD) (-DD.DDDDDD)
1 c. Property size: 0.012 acres
2. SurFace Waters
2a. Narne of nearest body of water {stream, ri�er, etc.) to Knob Creek and UT to Knob Creek
proposed project:
2b. Waier Quality Classi�ication of nearest receiving water: C
2c. River basin: , Broad
3. Project I]escription
3a. Describe the existing conditions on the site and the general land use in t�e �icinity of the project at the time af this
application:
Existing 121-foot timber bridge and a 42' CMP with headwalls; Larod use around praject site is mostly #orested; bridge
and pipe is an paved secondary road.
3b. List the tota� estimated acreage of ail existing wetlands on the pro�erty:
0
3c. List #he total estimated linear feet of aff existing streams (intermittent and perennial) on the property:
400 feet
3d. Explain the pur�ose of the proposed project:
The purpose of the proposed work is to replace the de#eriorating bridge and culvert for khe safety of the travelling public.
3e. Describe the o�erall project in detail, including the type of equipment to be used:
The North Carolina Department of Transportation requests authoriza#ion to replace an existing 121-foot long X 20.2 foot
wide timber deck bridge with a 130-ft long x 27 ft wide concrete bridge on SR 1603 (Carpenier FEoyle Raad} in Cle�eland
County. NCDOT proposes to place a total of 4 feet of rip rap for a deck drain pad under Bridge #275. Also NCDOT
request authorization to replace an existing 58-foot long 42" CMP with a 100-foot long 60" RCP in the same vicinity.
NCDOT proposes to place a total of 20-feet of ripra� upstrearn and downstream of the new pipe for sta�ilization. There
will be 40 feet of temporary impacts to Knab Creek associated with the existing end bent remo�al and 224 feet of
temporary dewatering impacts assoicated with the culvert replacement. Areas affected by tempo�ary impacts will be
restored to preproject conditions. AE[ Best Management Practices will be uUlized during the course of the project. �he
� Project will be constructed using iypical hea�y equipment (trackhoe, backhoe, etc.)
� 4. Jurisdictional Determir�ations
4a. Have jurisdictional wetland or stream determinations by the
Corps or Sta#e been requested or obtained for this property 1
project (including ali prior phases) in the past? ❑ Yes � No ❑ Unknown
Comments: Jurisdictionai stream determination mad� by E
Di�ision 'I2 DEO.
4b. If ihe Corps made the jurisdictional determinatfon, what type ��reliminary ❑�inal
of determination was made?
; 4c. If yes, who deiineated the Jurisdictionai areas? AgencylConsultant Company:
� Name (if known): Other:
' 4d. If yes, list the dates of the Corps jurisdiciianal determinations or State determinations and attach documentation.
Page 3 of 1 �
PCN Form — Version 1.3 December 10, 2008 Version

5. Project Nistory
5a. Have perrnits or certifications been requested or obtained for � Yes � No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in c�etail according to "help fileU instructions.
6. Future Praject Plar�s
6a. [s this a phased project? ❑ Yes � No
6b. !f yes, explain.
Page 4 of 11
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts fn�entory
1. Impacts Summary
1a. Which sectior�s were corx�pEeted below for your project (check a!I that apply):
❑ Wetlands � Streams - tributaries ❑ Bu�#ers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
! I# there are wetland impacts proposed on the site, then complete this questior� for each wetland area impacted.
' 2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number — Type of impact Type of wetland Forested (Cor�s - 404, 10 Area of impact
Permanent (P) or (ff known) DWQ — non-404, other) (acres)
Tem ora T
W 1❑ P � 7 ❑ Yes ❑ Corps
❑ No ❑ DWQ
W2 ❑ P 0 T ❑ Yes ❑ Corps
❑ No ❑ DWQ
� W3 ❑ P❑ T ❑ Yes ❑ Carps
❑ No ❑ DWQ
W4 ❑ P � T � ❑ Yes ❑ Corps
❑ No ❑ DWQ
WS ❑ P❑ T ❑ Yes ❑ Corps
� ❑ No ❑ DWQ
WS � P� T ❑ Yes ❑ Corps �
❑ No ❑ DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
!f there are perennial or intermittent stream impacts {including temparary 9mpacts) pro�osed o� the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3#. 3g.
Stream impack Type of impact Stream name Perenniaj I iype of jurisdiction Average Impaci
number - PER or
( ) {Corps - 404, 14 stream length
Permaneni {P) or intermittent DWQ — non-404, width (linear
� Temporary (T) {IN'f)? other} (feet) fee#)
S1 � P❑ T Deck Drain Pad Knob Creek � PER � Corps �5 4
i ❑ INT � DWQ
52 ❑ P� T Existing End Benk Knob Creek � PER � Corps 23 **40
Remaval E ❑ INT � DWQ
Pipe Replacment � p�� � Corps
: S3 � P❑ T (increase in pipe Lit to Kno� Creek 25 42
I length) ❑ INT � DWQ
54 � P❑ T Rip rap bank �t to Knoh Creek � PER ,� Corps 4 20
stabilization , ❑ INT � DWQ
Temporary ; �
Dikeslbewaterin ' � PER � Cor s
+ S5 ❑ P� T gtream placecf in ` �t to Knob Creek ��NT � DWQ 4 `*224
� Di�ersion Channel �
i S6 ❑ P❑ T i � ❑ P�R �❑ Corps
❑ 1NT � ❑ DWQ
3h. Total stream and tributary impacts *g6
3i. Comments: *Total Permanen# fmpacts = fi2ft. �'"Total temporary irrtpacts = 264 feet
Page5af11
PCN Form — Versian '!.3 December 10, 2008 Version

4. Open Water impacts
if there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, khe Atfantic Ocean, or any other open waker of
the U.S. then indi�idually 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) vr
Tem ora T
01 ❑P❑T +
02 ❑P❑T
03 ❑P�T
04 ❑P❑T
4f. Tatal open water impacts
4g. Commer�ts:
5. Pond or Lake Construction
If onci or lake construction ro osed, then corn lete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet} iJpland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Exca�ated Flooded F911ed Excavated Flooded
�1
P2
Sf. Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, perrnit ID no:
5i. Expected pand surface area (acres):
5j. Size of pond watershed (acres}:
5k. Method of construction:
6. BufFer Impacts (for DWQ)
If project wil! impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. lf an impacts re uire miti ation, then ou MUST fill out 5ection D of this fvrm.
6a.
❑ Neuse ❑ Tar-Pamlico ❑ Other:
Projsct is in which protected basin? ❑ Catawba ❑ Randleman
6b. 6c. 6d. 6e. 6f. Bg.
Buffer irnpact
number — Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for 5tream name mitigation {square feet) (square feet)
Tem ora T im act re uired?
❑ Yes
81 ❑P�T ❑No
B2 ❑P❑T ❑Yes
❑ No
B3 ❑P❑T ❑Yes
❑ No
6h. Total buffer impacts
6i. Comments:
Page fi of 11
PCM Form — Version 1.3 December 10, 2008 Version

D. Impact Justifica#ion and Mitigation
1, Avoidance and Minimization
9a. Specifically describe measures taken to avoid or minimize t�e proposed impacts in designing �roject.
Bridge being replaced with bridge, no bridge supports in water. No direct discharge to strearn from bridge. Stormwater runof#
directed to riprap energy dissipation prior #o entering stream. The new culvert will reconnect upstream and downstream bed
elevations (current pipe is perched).
1 b. Specifically describe measures taken to avoid or minimize the proposed irnpacts through construction techniques.
2. Campensatory Mitigation for Impacts tv Waters of t�e U.S. or Wa#ers of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is requirecl by (check all that apply):
2c. If yes, which mitigation option will be used for this
project?
3, Compfete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
❑ Yes � No
❑ DW Q ❑ Corps
❑ Mitigation bank
❑ Payment to in-lieu fee program
❑ Permittee Responsible Mitigation
Type
4a. Approvai letter from in-lieu fee program is attached. ❑ Yes
Quantity
4b. 5tream mitigation requested: linear feet
4c. If using stream rr�itigation, stream temperature: ❑ warm ❑ cool
4d. Buffer mitigation requested (DWQ only):
4e. Riparian wetland �itigation requested:
4f. Non-riparian wetland mitigation req�ested:
4g. Coastal (tidal) wetland mitigation requested:
4h. Comments:
5. Complete if Using a Permittee RespoAsible Mitigation Plan
square feet
acres
acres
acres
❑cold
5a. If using a perrnittee responsible mitigatian plan, provide a description of the proposed mitigation plan.
Page 7 of 11
PCN �orm — Ve�sion 1.3 December 10, 2008 Version

6. 6uffer Mitigation (State Regulated Riparian Buffer Rules} — required by DWQ
6a. Wil! the project result in an impact within a pro#ected riparian buffer that requires ❑ Yes � No
bufFer mitigation?
6b. If yss, then identify the square feet of impact to each zone of the ripa�ian buffer t�at requires mitigation. Calculate the
amount of mitigakion required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 3{2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
Bg. If buffer mitigation is required, discuss what type of mitigadon is proposed (e.g., payment to pri�ate mitigation bank,
permittee responsible riparian buffer restoration, payment into an appra�ed in-lisu fee fund).
6t�. Comments:
Page 8 of 91
PCN Form — Version 1.3 December 1 D, 2008 Version

E. Stormwater Management and DifFuse Flow Plan {required by DWQ)
1. Diffuse F�ow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified
within one of the NC Riparian Buffer Protection R�les?
E 1 b. If yes, then is a diffuse flow plan included? If no, explain why.
� Comments:
2. Stormwater Mana�ement Plan
2a. What is the overall percent impen�iousness of this project?
2b. Does this projeck require a Stormwater Management Plan?
2c. If this project DOES NOT require a Sforrnwater Managernent Plan, explain why:
❑ Yes � No
❑ Yes ❑ No
New bridge slightly wider; therfore,
there is an 0.14 acre increase
in built upon area %
� Yes ❑ No
2d. If this project DOES require a Stormwater Management Plan, then pra�ide a brief, narrati�e description af the plan:
See ai#ached SMP spreadsheet documentation
2e. Who will be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a. In which local go�ernment's jurisdiction is this project?
3b. Which of the following locally-implemented stormwater management programs
apply (check all that apply):
3c. Has the appro�ed Stormwater Management Plan with proof of approval been
attached?
4. DWQ Stormwater Program Review
�a. Which of the folfowing state-implemented stormwater management programs apply
(check all that apply}:
4b. Has the approved 5tormwater Management Plan with proof of appro�al been
attached?
5. DWQ 401 UniE Stormwater Review
5a. Does the Starmwater Management Plan meet the appropriate requirements?
5b. Have all of the 401 Unit submittal requirements been met?
❑ Certified Local Government
❑ DWQ Stormwater Program
� DWQ 409 Unit
NA
❑ Phase !I
❑ NSW
❑ IJSMP
❑ Water Supply Watershed
❑ Other:
❑ Yes ❑ No
❑ Coasial counties
❑ MQW
❑ ORW
❑ Session Law 20afi-246
❑ Other:
❑ Yes ❑ No
� Yes ❑ No
� Yes ❑ No
Page 9 of 11
PC{V Form — Version 1.3 December 10, 2008 Version

F. Supplementary Informatian
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public {federallstatellocal) funds or the � Yes ❑ No
use of public (federallstate) land?
9 b. If you answered "yes" ta the above, does #he project require preparation of an
e��ironrnental document purs�ant to the requirements of the National or State ❑ Yes � No
{North Carolina) Environmental Policy Act (NE�AISEPA)?
1 c. If you answered "yesu to the aba�e, has the document re�iew been #'inalized by the
State Clearing House? (If so, attach a copy of the NEPA ar SEPA final appra�al
letter.) ❑ Yes ❑ No
Comments:
2. Violations (DWQ Requ�rement)
2a. Is the s�te in �iolation of DWQ Wetland Rul�s (15A NCAC 2H .0500}, ksolaked
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland 5tandards, ❑ Yes � No
or Riparian Buffer Rules (15A NCAC 2B A200}?
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, pro�ide an exptanation of the viola#ion(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Wil� this project {based on past and reasonably anticipated fuiure irrtpacts} result in � Yes � Na
additional de�elopment, which could irr�pact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulafi�e impact analysis in accordance with the
most recent DWQ policy. If you answered "no,9 pro�ide a sho�t narraii�e description.
The project is a minimum criteria projeci which has law potential for cumulati�elindirect impacts and wiil not result in
addikiona� de�elopment which could impact water quality.
4. 5ewage Disposal (QWQ Requirementj
4a. Clearly dekail the ultimate treatment methods and disposition (non-discharge or d9scharge) of wastewater generated from
the proposed project, or a�ailable capacity of the subject facility.
No wastewater generated form proejct.
Page 10 of 11
PCN Form — Version 1.3 December 10, 2008 Versfon

� 5. Endangered Species and Designated Critical Habitat (Corps Requirementj
i
� 5a. Wi{I this project occur in or near an area with federally protected species or � Yes � No
habitat?
5b. Ha�e you checked with the USFWS conceming Endangered Species Act � Yes ❑ Nv
impacts?
❑ Raleigh
5c. If yes, indicate the USFWS Fisld Office yo[a ha�e contacted.
� Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC Natural Heritage Program database and on-site surveys.
6. Essential Fish Habita# (Corps Requirement)
8a. Will this project occur in or near an area designated as essentia� fish ha�itat? ❑ Yes � No
6b. What data sources did you use to determine whether your siie would impact Essential Fish Habitat?
No salt marshes, oyster reefs, or seagrass beds located in viciniry of project.
7. Historic or Prehistoric Cultura� Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments ha�e designated as having historic or cultural preser�ation � Yes � No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What daia sources did you use to determine whether your site would impact historic or archeological resources?
Culkural Resources re�iew. Tracking number {15-10-0005).
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 1d0-year floodplain? � Yes ❑ No
8b. If yes, explain how project meets FEMA requirements: NCDOT Hydraulics coordination with FEMA
i 8c. What source(s) did you use to make the floodplain determination? NC Floodplain Mapping Program
i http:llfris.nc.govlfrisllndex.aspx?FIP5=097&ST=NC&user=General%201'ublic
� �
� ���� �
,� -�-�.�� r� ��� c - c � ` J� ' � y r ,�
App�icantlAgent's Printed Name ApplicantlAgent's Signature Date
{Agent's signature is valid only if an au#horization letter from the applicant
is rovided.
Page 11 of 11
PCN Form -- Version 1.3 December '! 0, 2008 Version

�OYII
Hj hy,wc�Y NoRh Carolina bQpartment of TransportatioR c
�t��ii7�1n�=,al�Ll � .i �
� � � {'�O�i1W8y':�0�71'i1H8�BCPfOQrdRi ��J' .
�.m�n.y,.
�
ST�CIRMV4fATfR iVfA�IAGEMfNT P#.AA1
(Vers�nn 1 Z, Relcased Juy 4412y fOR L1IVEAR I�dADWAY F'ROJECTS
Pro'ectl'fIP No.:`� 17BP.i2.R.43 Count ies : Cleveland Pa e 9 of 1
General Project Ir�formalipn
Pro'ect No.: 17BP.12.R.43 Pro'sctT e: Brid e Re laceme�t �ate: 2li12017
NGDOT Contact: Ste�e Rackfe Contractnr! Desi ner: Michaaf Baker En ineerin , Inc. ' T� ��
Address: 171 Q E, Marion 5t. Address: SQQQ Regency Parkway
5helby, NC 28151 5uite 800
Ga , NC 27518
Phone: 704a$0-9D34 Phone: 919-4fi3-5488
Email: srackle ncdvt. ov Email: Tocfd.Buckner mhakerintl.com
Cit lTown: Belwood Count ies : Cle�eland
Ri�►er Basin s: Broad CAMA Count ? No
Prima Recei�in Water: Knob Creek into First Broad River NCDWQ Stream Index No.: 9-24
NCDWQ $urFace Waier Classification for Primary Recei�ing Water Prima : Class C ��
Su lemental: Nane
Other Stream Classifiaafion: Nane �
303 d Im airments: Nane T
Buffer Rules in Eifect NIA
Pro'ect �escri fon
Pro'ect !en h �in. M�ies or feet : 0.132 MI Surroundin Land Use: Rural
Pro vsed Pro ect Existin SKe
Pro'ect Built-U pn Area ac. 0.41 ac. 027 ac.
Typical Cross Section Desaription: Two-lane 20' asphalt roadway with 3' turt shoulders Two-lane 17' asphalt paved roadway with 5' turt shoulders.
A�erage Daily Tra�c {vehlhrlday): Desi nlFuture: 140 Existin : � 1 AD
General Project Narrative: Tha existing bridge on Highway SR16D3 over Kno6 Creek (into First Broad River) in Claveland County is proposed to be re,placed with a 13U foot three span 2i" cqred slab
bridge. The exisGng approch sections of the roadway will be widened from approximetely 19f#. To 2�.8f1. The bridge crossing will be widened ftnm 2D TL to 27 ft. (ouf fo ouf).
The new bridge wilf have no direct discharge of stormwater into fhe stream. Stvrmwater runoff will be directed to rip rap for energy dissipafion prior to errtering receiving
waters.
'f .) hAaximizing shaulder section — A grass shvulder section is utifized on ihe project to promate d"�ffused passiue stormwater treatment.
2.} Minimizing roadway side slopes — Gentle and flat roadside slvpes have been utilized lo the maximum extent possible in locations while minimizing costs and ensuring
safery for embankment heights.
3.) Assessing and minimizing the impacts of siormwater runoff to environmentally sensitive areas — The stream and tributary within the project limits are hridged and piped in
the current condition. The project results in no new significant impacts to either the stream or kributary. There are no wetlands wiihin the projecl corridor.
4.} Pmmoting sensi�ve intersection of streams - The existing afignment of the stream crossing will be maintained ta minimize the bridge length and avpid significant costs and
right of way impacts.
1.) Pro�iding adequate ground cover — Apprapriate seed mixtures have baen specified for all seasons of planting. Erosion c:ontrol matting will he utilizerJ to minimire erosion
while vegetation is established.
2.) Siabilizing slopes T Erosion control matting will be utilized on 2:1 slopes
3.) Pra�iding adequate energy dissipation — Riprap energy dYssipators are proposed at pipe outlets. Riprap dissipator pads are proposed for bridge dech scupp�r loeations.
4.) Preserving natural features — Existing drainage pattems are maintained.
5.) Maximizing vegetativa conveyance — Vegetated ditches are proposed where applicable to promofe sedimentatfon, filfration, and mfdlration
8.} Encouraging diffuse @ow — F2iprap energy dissipators and dissipator pads are utilized fo difFuse flow at pipe outlets and bridge deck scuppers. No direct d�sc:harye will 6e
made to the stream irom khe deck scuppers.
References

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Conservation Serv3ce Nationa! CooperaEi�e Soil Survey Page '! of 3

NCDOT
HAZARDOUS SPILL BASIN CHECKL�ST
Division: 12 County: �"�P�P1an� Project ID:17BP.12.R.43
River Basin: Broad Bridge No: 275
Route: SR 1603
Water ualit Criteria:
Stream: Knob Creek
Stream Crossing Blue Line 4n USGS
ORW
WSI
WS II,III OR N, Crossing Within Q.Smi of W.S. Critical Area
Roadwav Criteria:
Route Designation-
Arterial Urban
Arterial Rura1
Addit�onal Site �nformat�on:
Is a Hazardous Spill Basin Required?
Yes No
Yes No
� r
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997).
Yes No
�
r
r
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r
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.��:� ��� �������� �55�5����� ��i��i
�d l�CD�T Bridges
� �.
ObserUers- �L�/ TIP or DOT project nurnber: �% :�� = i� , fi,3
DaieJTime- �fZ�i _. Raad Name/SR I�umber: f�,.Y�- b�:�e Sfi' 1�03
County_ �i�L�� uf Bridge Number: � �, �
Waterbody: ��i. _ Kn � t. �Trc f�
%Surrounding habita# w/in 1 mi.
of project footprint (approx)
Ur�an/comrrjercial
Naturaljrural�
Suburban/residential .�
Agr��ulturai ,�
Any trees >3" �BH within �roject footprint? yes na
Any shaggy trees or snags y5" D�H7 yes no
lf ves to shag/snag, how muth sunlight do they receive during the day7 1-3 ho�rs �4-6 �ours 7+ hours
If yes to s�ag/snag, list species of habitat trees >5" dbh ���i�c h „�, .,_... _._..,._._ .
If snags >�"�BH are present 9n sunlit areas, prov'tde pho#oS and lo�ation.
If large hailaw trees are present, pro�ide phatos and location.
Presence of: �n projec# fa�tpLint in vicinty (D.5 rr�'
Caues yes .� yes Fl
Abandoned mines yes � yes no
If `yes' to any ofi the aho�e, pro�ide phatos, descr�p#ion, a location.
Major water source in project favtprint: river st am/cree pond
Suitable drinking habita# in the form of non-stagnant, s�naoth or slack wate . �
Guard raiis none concrete #i ber
Deck iype co�crete metal ti
Beam type none concrete steE
Er�d/back wall type concrete timb masanry
Creosote evidence
Shallow vertical top sealed crevices (3� -1�" wide, 412" deep)
Deep uertical unsealed cre�ices (� -�3�" wide, 12+" ciaep)
metal
open grid
timber
yes
yes
yes
Max height of bridge decic a�ro�e ground/water (ft�: �.�
Night roost hab�tat prqtected es no
Bridge ajignrnent: � E/W NW/5E NE/5W
Hours of sun expasure to bridge Q-1 2-3 >3 `
Human disturbance under bridge high low ��none ,.�
Ernergence count perFormed7 (If yes, complete farm next page) yesf ' ��
Evidence of bats using bird nests, if present? yes �
Euidence of bats using bridge? tphotas needeci� ye5 no
Bat species present:
Additional Comments:
lake swamp
no
no
��
�
NCDOT Bat Bridge Habitat Assessment Fc
ll pdated 3/18,

Norfhern Lon -Eared Bat 4 d Rule Stre�mlined Consu�tahon Form
Federal agencies should use this form for the aptional streamlined consultation framework for the northern long-
eared bat (NLEB). This framewark allows federal agencies to rely upon the U.S. Fish and Wildlife Service's
(USFWS) danuary 5, 2016, intra-Service Programmatic Biological Opinion (BO) on the �ina� 4{d) rule for t�e
NLEB for section 7(a){2) complia�ce by: (1) notifying ihe USFWS tk�at an action agency will use the streamlined
framework; {2) describing the project witli sufficient detail to sup�ort the required determina�ion; and {3) enabling
the USFWS ta track effects and determiue if reinitiation af consultation is required per 50 CFR 402.16.
This form is not necessary if an agency determines that a proposed action will have no effect to the NLEB or if
the USFWS has concurred in writing with an agency's determination that a propased action may affect, but is not
likely to adversely affect the NLEB (i.e., the standard in%rmal consultation process). Actions that may cause
prohibited incidental take require separate farnaal consultation. Froviding tlus inforn�ation does not address
section 7(a){2) compliance for any other listed species.
Information to Determine 4(d) Rule
1. Doas the project occur wholly autside of tfie WNS Zoner?
2. Have you contacted the appropriate agenc}+z to determine if your praject is neat-
known hibernacula or maternit roost trees?
3. Could the project disturb hiberna,ting NLEBs in a known hibernaculum?
4. Could the project alter the entrance or interior environment af a known
hibernaculum?
S. Does the proje�t remove any trees within 0.25 miles of a l�own hibernaculum at
anv time of vear?
6. Would the project cut or destroy l�nown occupied maternity roost trees, or any
other trees within a I50-foo� radius from the maternity roost tree from June 1
through July 31.
�
■� 'Z�
►�� �
■� ►Z�
■0 ►1
You are e�igible to use this form if you have answered yes to question #I or yes to question #2 and no #o
ques#ions 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 Applicant� {Name, Emai1, Phone No.): NCDOT, Division 12, Trish Beam,
dbeam cdot. ov, 704-480-9044
Project Name: Bridge #275 replacement, SR 1603 {Carpenter Hoyle Road), Cleveland Caunty
Project Location (include coardinates if known):
Basic Project Description (provide narrative below or attach additional information): Replacement of
timber deck bridge with concrete bridge in same location.
1 http://www.fws.gov/midwest/endangeredlmammals/nleb/pdf/WNSZone.pdf
z See http://www.fws.gav/midwest/endangered/mammals/nleb/nhisites.hUn1
3 Tf applicable - only needed for federal actions with applicants (e.g., for a permit, etc.) who are party to the consultat�on.

�„-,� �,.,
A enc Determination:
By signing this form, the action agericy detenmines 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 s�xbmittal af this form, the action agency may
presume that its detern�ination is informed by the best available information and that its project
responsibilities under 7(a){2) wi#h respect to the NLEB are fulfilled through the USFWS January 5,
2016, Frogrammatic BO. The action agency will update this detetmination annually foz multi-year
activities.
The action agency understands that the USFWS presumes that all activities are implemented as
described herein. The action agency wi11 promptly report any departures from the described activities to
the apprapriate USFWS Field Office. The action agency will provide the appropriate USFWS Field
Office with the results of any suz-veys conducted for the NLEB. Invol.ved parties will promptly notify the
appropriate USFWS Field Office upon finding a dead, injured, or sick NLEB.
Signature: r
Date Submitted: � �- � � ' � �
4 Any activity that temporarily or permanently removes suitable forested habitat, including, but not iimited to, tree removal
from de�elopment, 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 unlmown, report the acreage as less than 0.1 acre.
6 If tlie activity includes tree clearing in June and July, also include those acreage in Apri1 to October.