20170271 Ver 1_permit_application_package_20170301

STATE OF NORTH CAROLINA
DEPARTIV�NT OF TRANSPORTATION
ROY COOPEIZ
GOVHItNOR
February 28, 2017
�Vfr. Steve Kichefski
Asl�eville Regulatory Field Office
U� Army Corp of Engineers
151 Patton Avenue
Asheville, NC 28801-5006
JAMES H. TROGDON, III
SECRETARY
SUBJECT: Bridge #78 Replacement on SR 1004 (Buffalo Shoals Road), Iredell County
Dear Mr. Kichefski:
The Nartb Carolina Deparhnent of Transportation requests authorization io replace an existing 3
span 127.5-foot long timber deck bridge with a 3 span 135-ft long concrete bridge on SR 1004
(Buffalo Shoals Road). NCDOT proposes to place a total of 65 feet of riprap bank stabilization
under Bridge #78 and 10 feet of riprap bank stabilization at the end of an 18 inch pipe. The pipe
is a stozranwater conveyance from a ditchline in the southwest quadrant. The pipe is necessary in
arder to maintain landowner cattle crassing access. An adjacent wetland will be impacted due to
moving t3ie new roadway and bridge to the south, which will prevent impacts to an adjacent
business landowner on the north side o�the existing bridge. There will be 0.08 acres of wetland
fill iznpacts, 0.03 acres of excavation impacts due to construction of a ditchline at the toe of the
new embanlcment slope, and 0.04 impacts due to mechanized land clearing. There will be 41
feet of temporary impacts associated with the existing and bents removal Areas affected by
temporary impacts wilt be restored to pre-project conditions. The scope of work will resu�t in a
total of 0.16 acres of impacts to a forested wetland adjacent to Third Creek, pl�s a total oi 75 feet
oipermanent bank stabilization impacts and 41 feet of temporary fill impacts to Third Creek
which is classified as Class C waters by the Division of Water Resources.
The Division 12 Environmental Off ce �onducted a threatened/endangered species surveys on
February 4 and March 2, 2016 for Bridge #78 and surroundi.ng areas. The federally listed
species for Iredell Couiaty (USFWS listed date July 2�4, 2015) is the dwarf flowered heartleaf
(Heacastylas nanaflora)-Threatened (T), Northern Long-Eared Bat (Myotis septentrionalis)-
Threatened (T), and bog turtle (Gdyptemys muhlenbergii)- Threatened due to Similarity of
Appearance {T/�A). Natural Heritage Program records document the nearest dwarf-flowered
heartleaf location appz�oximately 5.5 miles southeast 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. T�ere did not appear to be suitable habitat
withi.n the proposed project area and no species were obsezved. No impact ox� this species is
anticipated. The Natural Heritage Program records document the nearest Northern Long Eared
Bat location approximately 26 miles east of the proposed project a�rea. Duxing summer, northern
long-eared bats roost singly or in colonies underneath bark, in cavities, or in crevices of bath live

Bridge #78, Buffalo Shoals Road
February 28, 2017
Page 2
and dead trees. They may also roost in cooler places, like caves and mines. 'I�e closest listed
undexground mine, per NHI' database is the Powell Mine, located 6.9 rniles south of the project
site. There are currently no known hibernaculum or maternity roost trees in Division 12 counties
for NLEB; therefore, the bridge replacement, pipe replacement and any min.or tree clearing
associated witli this DOT project would be exempted from the incidental take u�der the 4{d}
Rule. I have attached a copy of the NLEB streamJined consultation form. Per guidance from
USFWS personnel, concurrence is granted by citi�ag the following website and a 30 day response
period is waived. http•//www.fws.�ov/asheville/htmislproiect review/NLEB_in WNC.html
The Natural Heritage Program records doctunent the nearest bog turtle location approximately
2.3 miles southeast of the proposed project area. Bog turtle habi.tat cansists of open,
groundwater supplied (spring fed), wetlands along riparian corridors or on seepage slopes. These
habitats are designated as mountain bogs by the NCNHP, but they are technically poor,
moderate, or rich fens that may be associated with wet pastures and old drainage ditches that
�ave saturated muddy substrates with open canapies. Species listed as threatened due to
similarity of appearance do not require Section 7 consultation with the USFWS. There is a
wetland being impacted by the project, but it does not e�chi6it suitable wetland habitat for bog
turtle; therefore na impact on this species is anticipated.
There are no sites listed on the National Register of Historic Places are located in the vicixuty of
the project nor did tliere appear to be any eligible structures. The project has been reviewed by
NCDOT's cultural resources staf� {NCDOT Culiural Resources Review — Internal Tracking No.
14-OS-00�4}. The project area is not located within 1/2 mile of any critical watershed area. SR
1004 is not a rural or urban arterial; therefore, hazardous spill basins are not required. Enclosed
is the hazardous spill basin checklist.
I have enclosed a pre-construction notification for a NW#14, plan sheets, and location maps
relative to the project.
Project information for the 401 Automated �ayment Procedure is as follows:
• Work order number: 150465-55120005-17BP.12.R.40-3372
• TIP#: NA
• Project Category: $240.00 Fee
If you have any questions or concerns please feel free to contact me at {704) 480-90�4. Thank you for
your time and consideration on this matter.
Sincerely,
Matk Stafford, P.E.
Division Engineer
Twelfth Division
BY: /���`r.--
Trish Beam
Division 12 Environmental Supervisor
Enclosures

Oifiee Use Only:
Carps action ID no.
QWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Noti�cation CN} Form
A. A licant Information
1. Processing
1a. Type(s} of appro�al sought from the
Corps: � Sectian 404 Permit ❑ Section 10 Permit
1 b. Specify Na6onwide Permit (NWP) number: 14 or General Permit {GP) number: I
1 c. Has the NWP or GP number been verified by the Corps? ❑ Yes � No
9d. 7ype(s) 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 Authorization
' 1e. Is this notification soleiy for the record For the record only for DWQ 401 For the record only for Corps Permit:
because written approval is not req�ired? Certification:
❑ Yes � No ❑ Yes � No
1f. Is payment into a mitigatian bank or in-lieu fee program proposed for mitigation � Yes � No
of impacts? If so, attach the acoaptance letter from mitigation bank or inaieu
fee program.
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h ❑ Yes � No
below.
'fh. Is ihe project located within a NC DCM Area of Environinental Concem {AEC)? ❑ Yes � Nv
2. Project Information
2a. Name of project: Bridge #78, SR 1004 (Buffalo Shoals Road)
2b. Caunty: Iredell
2c. Nearest municipality 1 town: Statesville
2d. S�bdivision name:
2e. NCDOT only, T.I.P. or state � 7BP.12.R.40
project �o: E
3. Owner Information
3a. Name(s) on Reoorded Deed: NC DOT Right of Way
3b. Deed Book and Page No.
3c. Responsible Parly (for LLC if ,
applicable): �
3d. Streetaddress: ` j
3e. City, state, zip: !
�
3f. Telephone no.: ,
3g. Fax no.: ;
3h. Emai1 address:
Page 1 of 11
PCN Form — Version 1.3 December 10, 20Q8 Version

4. Applicant Information (if difFerent from ownerj
4a. Applicant is: ❑ Agent ❑ Other, specify:
4b. Name: Mark 5tafford
4c. Business name �,C. Department of Transportakion, Di�ision 12
(if applicable}:
4d. Street address: 1710 East Marion Street
4e. City, state, zip: Shelby, NC 28151
4f. Telephone no.: 704-480-9020
4g. Fax no.: 704-480-5401
4F�. Emai! address: [e-mail]�
5. AgentlConsultant Information (if applicable)
5a. Name: Trish Beam
5b. Business name N.C. Department of Transportation, Di�isian 12
(if applicable};
5c. 5treet address: 1710 East Marion Street
5d. City, state, zip: Shelby, NC 28151
5e. Telephone no.: 7D4-480-9044
5f. Fax no.: 7U4-480-5401
5g. Email address: [e-mail]�
Page 2 of 11
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
9a. Property identificatian no. (tax PIN or parcel ID}: � NA
1 h. Site coordinates (in decimal degfees): ; Latitude: 35.76284 Longitude: - 80.92108
; (DD.D�d�D�) (-DD.D�DDDd}
1 c. Property size: 2.5 acres
2. Surface Waters ,
2a. Name of nearest body of water (stream, river, etc.) to ; Third Creek
proposed project:
2b. Water Qualiiy Classification of nearest receiving water: ; C
2c. River basin: ; Yadkin Pee-Dee
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the �icinity of the project at the time of this
application:
Existing timber bridge on pa�ed secondary road; Land use around project site is commercial, residentiallopen farmland
3b. List the total estimated acreage vf all existing wetlands on the property:
a
3c. List the total estimated linear feet of all existing streams {intermittenk and perennial) on the property:
'f 00 feet
3d. Explain #he purpose of the proposed project:
The purpose of the proposed work is to replace the deteriorating bridge for the safety of khe tra�elling public.
3e. Dascribe the overall project in detail, including the type of equipment to be used:
The North Carolina Department of Transportation requests authorization to replace an existing 3 s�an 127.5-foot long
timber deck bridge with a 3 span 'I35-ft long concrete bridge on SR 1004 (BufFalo Shoals Road). f�CQOT proposes to
place a#otal of 65 feet of riprap bank siabilization under Bridge #78 and 1 U feet of riprap bank stabilization at the end of
an 18 inch pipe. ih� pipe is a stormwater conveyance from a ditchline in the southwesk quadrant. The pipe is necessary
in order to maintain landowner cattle crossing access. An adjacent wetland wil! be impacted due to mo�ing the new
roadway and bridge to the south, which will prevent impacts to an adjacent business landowner on the north side of the
existing bridge. There will be a.08 acres of wetfand fill impacts, D.03 acres of exca�ation impacts due to construction of a
ditc�line at the toe of the new embankment slope, and 0.04 impacts due to mechanized land clearing. There will be 41
feet of temporary impacts associated with the existing end bents remo�al Areas afFected by temporary impacts will be
restored to prepraject conditions. All Best Management Practices will be ufilized during the course of the project. �he
Project will be constructed using typical heavy equipment (tracfchoe, backhoe, etc.)
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requeskeci or obtalned for this property 1
I project (including all prior phases) in the past?
� Comments: Jurisdictional stream determination made by � Yes ❑ No ❑ Unknown
I Division �2 DEO. Regulatory site �isit by USACE and DWR
to �erify wetland. �
� 4b. if the Corps made the jurisdiciional determinaiion, what type
of determination was made? � Preliminary ❑ Final
� 4c. if yes, who delineated the jurisdictional areas? AgencylConsultant Company: USACEIDWR
Name {if known}: Steve KichefskilDonna Haod Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
I
i
Page 3 of 11
PCN Forrr� — Version 1.3 December 10, 2008 Version

5. Praject History
5a. Have permits or certificativns been requested or obtained for � Yes � No ❑ Unknown
this project {including aN prior phases) in khe past?
5b. lf yes, explain in detail according to "help file" instructions.
G. Future Project Plans
Ba. Is this a phased project? ❑ Yes � No
6b. If yes, explain.
Page 4 of 11
PCN Form — Version 'f .3 December 10, 2008 Version

C. Proposed Impacts lnventory
1. Impacts Summary
1 a. Which sections were corrtpleted below for your project (cheek all #hat apply):
� Wetlands � 5treams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
'!f there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type af jurisdiction
number — 7ype of impact Type of we�and Forested (Corps - 404, 10 Area of impact
Permanenk (P) or (if known) DWQ — non�04, ot�er) (acres)
Tem ora T
W1 � P❑ T Road fil! Forested WeUanci � Yes � Corps a.08
❑ No � bWQ
W2 � P� T Exca�atian for Forested Wetland � Yes � Corps 0.03
ditchline ❑ No � DWQ
Mechanized E.and � Yes � Corps
W3 � P � T Clearing For�sted Wetland ��o � pWQ 0.04
W4 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W� � P� T ❑ Yes ❑ Corps
❑ No ❑ DWQ
WB ❑ P❑ T ❑ Yes ❑ Corps
❑ Nv ❑ DWQ
2g. Tota! wetland impacts 0.15
2h. Comments: WeUand is a listed in National Wetland In�entory; estimated size per Arcmap data is 12.5 acres.
3. Stream lmpacts
If there ara perennial or intermittent stream impacts {including temporary impacts} proposed on the site, then complete this
q�estion for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
5tream impact Type of impact 5tream name Perennial Type of jurisdiction A�erage Impact
number - {PER) or {Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ — non�04, width {linear
Temporary (T} (INT)? other) (feet} feet)
Rip rap bank � PER � Corps
S1 � P❑ T stabilization under 7hird Creek � INT � pWq 25 fi5
bridge
Riprap bank
S2 � P � 7 stabiiization at Third Creek � pER � Corps 25 1D
, end of stormwater ❑ iNT � DWQ
pipe
S3 ❑ P� T Pier Remaval Third Creek � NT � �WQ � 25 41
S4 ❑ P❑ T i ❑ PER ❑ Corps i
❑ [NT ❑ [7WQ
S5 ❑ P � T ❑ PER ❑ Corps �
❑ ENT ❑ DWQ
Sfi ❑ P❑ T ❑ PER ❑ Corps
❑ fNi ❑ DWQ
3h. Total stream and tributary impacts *7�
3i. Comments: *Total Permanent Impacts = 75 ft. Total temporary impacts = 41
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 below.
4a. 4b. 4c. 4d. �4e.
Open water Name of wakerbody
impact number — (if applicable) Type of impaci Waterbody type Area of impact (acres)
Permanent (P} or
Tem ora T
01 ❑P❑T
02 ❑POT
Q3 ❑P❑T
04 ❑P❑T
4f. Total open wster impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construckion ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland lmpacts (acres} Stream Impacks (feet) Upland
Pond ID Proposed use or purpase (acres)
numt�er of pond
Floodeci Filled Excavated Flooded Filled Exca�ated Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ Na if yes, permit ID no:
5i. Expected pond surFace area (acres):
5j. Size of pond watershed (aeres):
5k. Method of construction:
6, Buffer 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 impacts re uire miti ation, then ou MUST fifi out Seetion D of this form.
Ba.
❑ Neuse ❑ Tar-Pamlico ❑ Other:
Project is in which proteoted basin? ❑ Catawba ❑ Randleman
6b. 6c. 6d. 6e. Bf. 6g.
Buffer impact
numbEr — Reason Buffer Zone 1 impact Zone 2 impact
Permanent {P) or for 5tream narne mitigakion (square feek) {square feet)
Tem ora T im act re uired?
B1 ❑P�T ❑Yes
❑ I�lO
B2 ❑P❑T ❑Yes
❑ No
B3 ❑ P ❑ 'f ❑ Yes
❑ No
6h. Total buffer impacts
8i. Comments:
Page6of11
PCN Form — Version 1.3 December 10, 2008 Version

� D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to a�oid or minimize the proposed impacts in designing project.
�` Fill slopes at (a�;9 to minimize impacts to wetland. Bridge being replaced with bridge with no bridge supports in water nor deck
drains aischarging to stream. Remo�al of existing bent in water. Bank stabilization under new bridge to reduce bank erosion.
� Storm drainage outlets to riprap pad to reduce velocity and diffuse �low. A�iprap embanlcment stabilization is included at the
� end of the 18" siormwater pipe to dissipate energy (The pipe is installed ko allow adjacent landowner ko maintain pasture
� access.)
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through canstruction techniques.
2. Com�ensatory Mitigatlon for Impacts to Waters of the �.S. or Waters of the State
2a. Does the project reguire Compensatory Mitigation for ❑ Yes � No
� impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is reyuired by (check all that apply): ❑ DWQ ❑ Corps
❑ Mitigation bank
2c. If yas, � hich mibgation option will be used for this � Payrr�ent to in-lieu fee program
project .
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantiiy
3c. Comments:
4. Complete if Making a Payment ta 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 mitigatian, stream temperature: ❑ warm ❑ cool ❑cold
4d. Buffer mitigation rec�uested (DWQ only}; square feet
4e. Riparian wetland mitigatian raquested: acres
4f. Non-riparian wetland mikigation requested: acres
4g. Coastal (tidai} wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigatian plan, provide a description of the proposed mitigation plan,
Page 7 of 11
PCN Form — Version 1.3 December 10, 2008 Versian

6. �uffer Mitigation (State Regulated Riparian BufFer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires ❑ Yes � No
buffer mitigation?
6b. If yes, then identify khe square feet of impact to each zone of the riparian bufFer that requires mitigation. Calculate the
amount of mitigation required.
6c. 6d. $e-
Zone Reason for impact Total impact Multipiier Required mitigation
(square feet) {square feet}
Zone 1 3(2 fior Catawba)
Zone 2 � •5
6f. Total buffer mit9gation required:
8g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoratian, payment into an appro�ed in-lieu fee fund).
6h. Comments:
Page 8 of 'I 1
PCN Form — Version 1.3 Deaember 10, 2008 Version

E. Stormwater Ma�agerrEeni and Diffuse Flow Plan (reqaired by DWQ)
7. Dlf#use Flow Plan
1 a. Does the project include or is ik adjacent to protected riparian buffers identified � Yes � No
within one of the tVC Riparian BufFer Pratection Rules?
1b. If yes, ihen is a diffuse flow plan induded? !f no, explain why.
Comments: ❑ Yes ❑ No
2. Stormwater Mana ement Plan
IUew bridge slightly wider and on
2a. What is the o�erall percent imperviousness of this project? new location.; therefore, there
is an 0.3 acre increase in built
�pon area %
2b. Does this project require a Stormwater Management Plan? � Yes ❑ No
2c. If this project DOES NOT require a Stormwater Management Pian, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
See attached documentation
❑ Certified Locaf Govemment
2e. Who will be responsible for the re�iew of the Skormwater Management Plan? ❑ DWQ Stormwater Program
� DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local go�ernmenYs jurisdiction is this project? NA
❑ Phase II
3b. Which af tF�e follawing locally-implemented stormwater management programs ❑ NSW
apply {check ali that apply): ❑ USMP
❑ Water 5upply Watershed
❑ Other:
3c. Has the appro�ed Stormwater Management Plan with proof of appro�al been ❑ Yes ❑ No
attached7
4. dWQ 5tormwater Pro ram Re�iew
❑ Coastal counties
❑ HQW
4a. Which of the following state-implemented stormwater management programs apply �� p�
(check aE! that apply}:
❑ 5ession Law 20Q6-246
❑ Other:
4b. FEas the a�proved Stormwater Management Plan wi#h proof of approval been
attached? � Yes ❑ No
5. DWQ 401 llnit Stormwater Revlew
5a. Does the Stormwa#er Management Plan meet the appropriate requirements? � Yes ❑ No
5b. Have all of the 401 Unit submit#al requirements been met? � Yes ❑ No
Page 9 of 11
PCN Form — Version 1.3 Decerr�ber 10, 2008 Version

F. Supplementary Information
1. En�ironmenial Documentation (DWQ Requirement)
1 a. Does the project invo{�e an expenditure of public (federallstatellocal} funds or the � Yes ❑ No
use of public (federallstate) land?
1b. If you answered "yes" to the abo�e, does the project require preparation of an
environmental document pursuant to khe requirements of the Nationai or State ❑ Yes � No
(Narth Carolina) En�ironmental Policy Act (NEPAISEPA)?
1 c. If you answered "yes" to the abo�e, has the document re�iew been finalized by the
State Clearing House? (Ifi so, attach a copy of the NEPA or SEPA final appro�al
lekter.) ❑ Yes ❑ No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in �iolation of DWQ Wetland Rules (15A NCAC 2H .050�), Isolated
Wetland Rules (15A NCAC 2H .130�}, DWQ Surface Water or Wetland Standards, ❑ Yes � No
or Riparian Buffer Rules {15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ❑ Yes � No
2c. If you answered "yes" to one or both of the above questions, pro�ide 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 � No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the abo�e, submit a qualitative or quantitative cumulati�e impact analysis in accordance with the
most recent DWQ policy. if you answered "no," provide a shart narrative description.
The project is a minimum criteria project which has low potential for cumulati�elindirect impacts and will not resuft in
additional der+elopment which could impact water quality.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non�lischarge or discharge} of wastewater generated from
the proposed project, or a�ailable capacity of the subject facility.
No wasterwater generated from project.
Page 10 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Wi�i this project occur in or near an area with federally protected species or Y
habitat? ❑ es � No
5b. Ha�e you checked with the USFWS concerning �ndangered Species Act Yes
irnpacts? � ❑ No
' ❑ Raleigh
� 5c. If yes, indicate the USFWS Field Offica you ha►re contacted.
� Ashe�ille
� 5d. What data sources did you use to determine whether your site wotald impact Endangered Species or Designated Cri#ical
Habitat?
NC Natural Heritage Pragram daiabase and on-site surveys.
6. Essential Fish Habltat (Corps RsquirementJ
6a. Wil� this prolect occur in or near an area designated as essential fish habitat? �❑ Yes � No
6b. What data sources did you use to determine whether your site wouid impact Essential Fish Habitat?
No salt marshes, oyster reefs, or seagrass beds located in �icinity of project.
7. Histarlc or Prehistoric Cultural Resources (Corps Requlrement)
7a. Will tF�is project occur in ar near an area that the state, federal or kribal
ga�ernments have designated as ha�ing hfsioric or cultural preservation �] Yes � No
status (e.g., National Historic Trust designatian or properties significant in
f�orth Carolina history and archaeolagy)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
CWtural Resources re►+iew. Tracking number (14-05-0004).
8. Flaod Zone Designation (Corps Requirement)
8a. WiIE this project occur in a FEMA{lesignated '[00-year floodplain? � Yes ❑ No
8b. If yes, explain how project meets FEMA requirements: NCDOT Mydraulics coordination with FEMA
8c. What source(s} did you use to make the floodplain determination? NC Floodplain Mapping Program
http://fris.nc.go�lfrisllndex.aspx?FIPS=d97&ST=NC&user=General%20Public
�+���C r ���� �- � �°.�� � �'� rr �
ApplicanUAgent's Printed Name ApplicantlAgent Signature Date
I(Agent's signature is valid only if an author¢ation letter from fhe applicant
is rovided.
Page 11 of 11
PCN Form — Version 1.3 December 10, 2008 Version

Bridge #78 Replacement
Buffalo Shoals Road (SR 1004)
Iredel! County
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MAP LEGEND
Area of Imarest (AOIj
�_ Area of Interest (AOq
Soils
is
n
Soil Map Unit Polygons
Soil Map Unit Lines
Soil Map Unit Poims
Specisl Point Features
� Btowout
� sor� Pn
� Clay Spat
'�
C�7
Closed Depression
Giavel Pit
Gravelly 5pot
Lendfill
Lave Flow
Marsh ar swamp
Mine ar Duarry'
Miscellaneous Water
Perennial Water
Rock Outcxap
Saline Spot
Sandy Spot
Severely Eroded Spot
Sinkhole
Slide or Slip
Sodic Spot
5oil Map—Iredell County, North Carolina
(Bridge #i8 Replacement}
spoil Area
Stony Spot
Veryr Stony Spot
1Net Spot
Other
5peciel Line Features
Water Fea�res
Streama and Canels
Transportatian
�.�, Rails
,�,. ___� Interstale Highways
US Rautes
Major Roads
Lacal Roads
Backgmund
� Aerial Nhotography
MAP INFORMATION
The soil sunreys thaf cemprise your Aa! were mapped at
1:12,000.
Warning: 5oil Map may not be valid at this scale.
Enlargemeni of ineps beyond the scale of mapping can cause
misunderstanding af the detail of mapping and accuracy of soil
line placement. The maps do not shaw the small areas of
coMrasting soils thai could have been shown at a more detaiked
Scale.
Please rely on the 6ar scale on earh map sheet for map
measurements.
Sourae of Map: Nalural Resaurces Conservation Service
Web 5oil Survey URL:
Coordinate System: Web Mercator (EPSG:3857)
Maps fram the We6 Soil Survey are based on the Web Mercator
projection, which preserves direction and shape but disiorts
distance and area. A projection that preserves area, such as ihe
Albers equa�area conic projection, should be used if more
accurate calculatians of distance or area are required.
This product ia generatad fram the U5��4NRCS certified data as
of the version date(s) listed below
Soil 5urvey Area: lredeli Caurriy, North Garolina
Sunrey Area Qata: Versian 21, Sep 15, 2015
3oil map �mits are lebeled (as space allows) for map scales
1:50,000 or larger.
Date(s) aerial images were photagraphed: Feb 11, 201 i�lllar 2,
2011
The orthophoto or other base map on which the soil lines were
compiled and digitized probably differs from the background
imagery displayed an these maps. As a result, some minor
shifting of map uni# boundaries may be e�ident.
USpsa, Natural Resaurces Web Soil Survey 2127�2�1�
� Conservation Servlae iVatianal Caoperati►re Soil Survey Page 2 of 3

Soil Map—Iredell CouMy, Narth Caralina
Map Unit Legend
Bridga #78 Raplecamant
hrdell CouMy, NoAh CuoMa [NC097�
Map U�rt �ymbol Wp Urrk Name Ileras m AOI Pase� of AOf
ChA Chevwada loam, 0 to 2 percent 0.8 28.1 %
slope& �quently flooded
PcD2 Pacolat aandy dey bam, 1 � to 0.1 3,296
15 percerrt sbpes,
mod�rately eroded
PrF Pofntlexle�-Rovran complex, 0.4 13.995
25 to 45 pereent alopes
RtA Riverview and Tocoaa soils, 0 1.1 38.2%
ta 2 perr�nt slopes,
occaslonalyfloctled
UfB Udorthenls�Urbenlantl 0.5 16.6%
compbx, 0 to S percsnt
elopaq rarely floodad
Tot�fs Tor Ana of lnhreat 5.8 100.0%
�Naturai Rraources 5nleb Sail Survey 2@712017
Conearvdlan Sarvke Netlonel Cooparetive 30119urvay Page 3 of 3

NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division: —12— County: roject ID:17BP.12.R.40
River Basin: Yadkin Bridge No: 78
Route: SR 1004
Water ualitv Criteria:
Stream: Knob Creek
Stream Crossing Blue Line On USGS
ORW
WSI
WS II,III OR IV, Crossing Withui O.Smi of W.S. Critical Area
Roadway Criteria:
Route Designation-
Arterial Urban
Arterial Rural
Additional Site Information:
Is a Hazardous Spill Basin Required?
Yes No
r r�
r �
Yes No
r �
Criteria Based Upon NCDOT "Best Management Practices for t11e
Protection of Surface Waters" (March, 1997).
Yes No
r
�
�
r

Northern Lon -Eared Bat 4 d Rule Stre�mlined Consultation Form
Federal agencies should use this form for the optional streamlined consultation fr�nework for the northern long-
eared bat (NLEB). This framework allows federal agencies to rely upon the U.S. Fish and Wildlife Service's
{LTSFWS} January 5, 2016, intra-Service Programmatic Biological Opinion {BO} on tlie 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 detai�l to support the required determination; and {3} enabling
the USFWS to track effects and determine if reini.tiation of 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 ar if
the USFW S has concurred in writing with an agency's determination that a proposed action may affect, but is not
likely to adversely affect the NLEB (i.e., the standard infarmal consultation process). Actions that may cause
prohibited incidental take require separate fornaal consulta#ion. Providing this information does not address
section 7(a)(2} compliance for any other listed species.
Information to Determine 4 d RuZe Com liance:
1. Does the proj ect occur wholly outside af the WNS
2. Have you contacted the appropriate agenc}+Z to determine if your project is near
known hibernacula or maternit roost trees?
3. Could the project disturb hibernating NLEBs in a known hibernaculum?
4. Could the proj ect alter the entrance or interior environment of a knawn
hibernacul�n?
5. Does the project remove any trees within 0.25 miles of a known hibernaculum at
an time of ear?
6. Would the project cut or destroy l�own occupied zx�aternity roost trees, or any
other trees within a 1 SO-foot radius from the maternity raost tree from June 1
t.�mu�h 7u1v 31.
You are eligible to use this form if you have answered yes to question #1 oX yes to question #2 and no to
questions 3, 4, 5 and 6. The remainder oFthe form will be used by the USFWS to track our assumptions in the
BO.
Agency and Applicant� (Name, Email, Phone No.}; NCDOT, Division 12, Trish Beam,
�dbeam(a��ncdot.�, 704-480-9044
Project 1`ame: Bridge #78 replacement, SR 1004 (Buffalo Shoals Road), Iredell County
Project Loeation (include coordinates if known}:
Basic Project Description (provide narrative below or attach additional informaiion): Replacement of
timber deck bridge with concrete bridge in same location.
1 http:l/www.fws.gov/midwest/endangeredlmammals/nleb/pdf/WNSZone.pdf
Z See http:l/www.fws.gov/midwest/endangeredlrnauim,alslnleb/nhisites.html
3 If applicable - only needed for federal actions witti applicants (e.g., for a permit, ete.) who are party to the consultation.

A�encv Determination:
By signing this form, the action agency determines 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 withix� 30 days from submittal of this £arm, the action agency may
presume that its determination is informed by the best available infozmation and that its project
responsibilities under 7(a)(2) with respect to the NLEB are fulfitled through the USFWS January 5,
2016, Programmatic BO. The action agency will update this determination annually for multi-year
activities.
The action agency understands that the USFWS pr�sumes that a11 activities are 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.
� c.
Signature:
Datc �ubmitted: � �� �'/
° Any activity that temporarily or permanently z�emo�es suitable forested habitat, including, but not limited to, tree removal
from development, energy pmduction and transmission, mining, agriculture, etc. (see page 48 of khe BO).
� 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 inc�udes tree clearing in June and )uly, also include those acreage in April to October.

Bat Habe�at Assessrnent F�rm
,�� NCQOT Bridges
Observers: TIP or QOT project number: � � Q
DateJ�ime: %1 Road Name/SR Number: �
County: Bridge Number: ��
Waierbody: (,� '"
95 Surraunding k�abi#at w/in 1 mi. UrbanJcommercial�_
of project footprint {a�proxj
Natural/ruraE„��
5uburbanJresiciential_ � �
Agricui#ural
Any trees >3" �8H wi#hin praject footprint? � �o
Any shaggy trees or s�r�gs 35" pgH7 es no
If yes io shag/snag, how much sunligh� do they receive cfuring the day? 1-3 hours 45 hours + hours
�f yes to shag�sr�ag, list species of habitat trees >5" dbh ���,.� �„ � �� � ��#�,
If s�nags ?5 DBH are pr�sent fr� sunlit areas, provide photos and iocation.
!i large hollow trees are present, pro�ide qhotos and locatlon.
Presence of: In proje�t footprint Rn vicinty �0,5 mi}
Ca�es yes yes �
A�andorsed rnines Ye5 � ye5
If'yes' to any of th� aidove, pro�ide photos, description, and locatian.
Major water saurce in project footpr��t: r v stream/creek pond lake
Suitable drinking habitat in the form af non-stagnant, smooth or slack water? ye nfl
Guard raiEs
Deck type
Beam type
�n�/back uvall type
Creosote evidence
nane ncre timber
cr metal tirnber
none concrete �
�i `�� timber masanry
Shallaw vertical tnp sealed crevices {�h - 3.�6" wEde, 4-12° deep)
Deep uertical unsealed crevices (% - 1�" wide,l2+" deep)
Max height o# bridge deck ehove graund/water {ft):_��'�
Nigf�t roost habitat protected � �a
Bridge alignr�r�errt: Nf5 E/W NWJS�
Hours of sun expasure to bridge 0-1 2-3 �
iiurnan distt�rbance under bridge f low none
�mergente tount pertormed? (If yes, cnr��iete farm next �age) yes
E�idence of bats using bird ne�ts, if present? y�5
Evidence of t�ats using bridge? (pt�otas neededj ye�
Bat s�ecies present:
Additional Comments:
metai
open grid
timber
yes
es
Y�
E/s
n
0
swarnp
�'
no
�
NWOT Bat 8ridge IiablqtASsessment Forn
Upcfated 3/18/1!