HomeMy WebLinkAbout20170429 Ver 1_NW-13 permit application_20170410ROY COOPER
GOVERNOR
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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
April 10, 2017
Mr. James Lastinger
Regulatory Specialist
Raleigh Regulatory Field Office
US Army Corps of Engineers, Wilmington District
3331 Heritage Trade Dr.
Suite 105
Wake Forest, NC 27587
SUBJECT: Nationwide Permit #]3
Main Street (Bethania) SR 1611
WBS Project no.: 9203411 (DWR permit fee $240)
Forsyth County
Dear Mr. Lastinger,
J�s H. TkoGDox, III
SECREiARY
We are requesting a Nationwide 13 permit for bank stabilization work. The stream will be relocated to
allow for adequate road shoulder before installing the gabion baskets for safety. In addition to the gabion
baskets and stream relocakion, NCDOT will also be replacing the terracotta pipes shown on the plans with
concrete pipes. Over the years, the ditch line has accumulated a large amount of sediment that needs to be
removed. Currently the ditch line is gass; it will be replaced with grass so the area will look just as it
does now once the work is complete.
I have attached a pre-construcrion notification applicarion, a topography map with the project area circled,
and a vicinity map. Also attached are Northern Long-eared Bat (4d) Rule Streamlined Consultation Form,
and the construction plans. The project is located in the Bethania Historic District which prompted a
survey of the area by NCDOT Historic Architecture and Landscapes. A`No Adverse Effects'
determination was made and submitted on Apri14, 2017 (see attached). NCDOT Archaeological
Resources submitted a`No Archaeological Survey Required' form on February 14, 2017.
The project will permanently impact 115- lineaz feet (bank stabilization) and temporarily impact 10 linear
feet (dewatering) of Muddy Creek (Class C). The site will be dewatered during construction in
accordance with NCDOT's Best Management Practices.
The USFWS lists Small-anthered bittercress (Cardamine micranthrea) as endangered and the Northern
Long-eared bat (Myotis septentrionalis) (NLEB) as threatened in Forsyth County. The location is outside
of the Dan River Watershed; therefore, there will be no effect of Small-anthered bittercress. There is
habitat for NLEB but there are no known maternity roost irees within 150.foot radius of the project and
there are no known hibemaculum within 0.25 miles ofthe project area, it was determined that the project
may affect but is not likely to adversely affect (MANLAA) the NLEB. See attached Northem Long-eared
Bat (4d) Rule Sb•eauilined Consultation Form. Although there is habitat for the NLEB, NCDOT will not
be cutting any trees for this project.
MuilingAddress:
NC DEPARTMENT OF 1RANSPORTAT[ON
DNISION 9
375 SILAS CAEEK PARKWAY
WINSTON-SALEM,NC 27@�
Telephone:(336)747-7800
Far. (336) 703L693
Cvstomer Service: 1-877-368-4968
Websire: www.ncdoteov
Location:
375 SILAS CREEK PARKWAY
WINSTON-SALEM, NC 27127
By copy of this letter, we also request 401 review and approval from the NC Division of Water Resources
related to the stream relocation. One copy of the applicarion package will be provided to Amy Chapman,
Transportation Permitting Unit Supervisor, and Dave Wanucha, DOT Project Coordinator. Please charge
the application fee of $240 to WBS project no. 92034] 1.
If you have any questions, comments or need additional information after reviewing this material please
contact me at scbraquetCcr�ncdot.gov or (336) 747-7800. Thank you for your cooperation in this matter.
�Steph�nie Braquet
Division Environmental
NCDOT Division 9
Attachments: Application Package
CC: Kristi Carpenter, NCDENR-DWR, Adminislrative Assistant-e-copy
Daue Wanucha, NCDENR-DWR, Environmental Specialist-e-copy
Mazla Chambers, NCWRC-NCDOT Coordinator, Habitat Conservation Program-e-copy
Marella Buncick, USFWS-Fish and Wildlife Biologist-e-copy
Kevin Neal, P.E., NCDOT-Forsyth County Maintenance Engineer
Phil Suggs, NCDOT- Area Roadside Environmental Engineer- e-copy
O�OpWATFROG
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Office Use OMy:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the Corps: OX Section 404 Pertnit ❑ Section 10 Permit
1b. Specify NaGonwide Permit (NWP) number: 13 or General Permit (GP) number: 4087
1c. Has the NWP or GP number been verified by the Corps? ❑ Yes �X No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
0 401 Water Quality Certification — Reguiar ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e. Is this notification solely for the record For the record only for DWQ For the record only for Corps Permit:
because written approval is not required? 401 CeAification:
❑ Yes Q No ❑ Yes � No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for
mitigation of impacts? If so, attach the acceptance letter from mitigation bank � Yes � No
or in-lieu fee program.
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h � Yes � No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concem (AEC)? ❑ Yes � No
2. Project Informatlon
2a. Name of project: Bank stabilization Main Street (Bethania) SR 1611
2b. County: Forsyth
2c. Nearest municipality / town: Bethania
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state project no: 9C.203411
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT Division 9
3b. Deed Book and Page No.
3c. Responsible Party (for LLC ff pat Ivey, P.E. Division Engineer
applicable):
3d. Street address: 375 Silas Creek Parkway
3e. City, state, zip: Winston-Salem, North Carolina 27127
3f. Telephone no.: 336-747-7800
3g. Fax no.: 336-703-6693
3h. Email address: pivey@ncdot.gov
Page 1 of 10
PCN Form — Version 1.4 January 2009
4. Applicant Information (if different from owner)
4a. Applicant is: ❑ Agent ❑X Other, specify:
4b. Name: Stephanie Braquet
4c. Business name NCDOT Division 9
(if applicable):
4d. SVeet address: 375 Silas Creek Parkway
4e. City, state, zip: Winston-Salem, North Carolina 27127
4f. Telephone no.: 33fi-747-7800
4g. Fax no.: 336-703�693
4h. Email address: scbraquet@ncdot.gov
5. Agent/Consultant Information (if applicable)
5a. Name:
5b. Business name
(if applicable):
5c. Street address:
5d. Ciiy, state, zip:
5e. Telephone no.:
5f. Fax no.:
Sg. Email address:
Page 2 of 10
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): N/A
1b. Site coordinates (in decimal degrees): Latitude: 36.1902 Longitude: -80.3376
1c. Propertysize: 0.01 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: Muddy Creek
2b. Water Quality 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 vicinity of the project at the time of this
application:
The existing site is a 2-lane paved road with a grassed dRch line. The sunounding area is residendal and forested.
3b. List the total estimated acreage of all existing wetlands on the property: 0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 50
3d. Explain the purpose of the proposed project:
Bank stabilization for adequate road safety, terrecotta ptpe replacementwith reinforced concrete pipes, and cleaning out the ditch line.
3e. Describe the overall project in detaii, including the type of equipment to be used:
Bank stabilization, pipe replacement, and ditch work. A track hoe, dump truck, and pumps will be used.
4. Jurisdictional Determinations
4a. Have jurisdictional welland or stream determinations by the � Yes ❑X No ❑ Unknown
Corps or State been requested or obtained for this property /
ro'ect includin all rior hases in the ast? Comments:
4b. If the Corps made the jurisdictional detertnination, what type
of determination was made? ❑ Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas? Agency/Consuftant Company:
Name (if known): Other.
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for � Yes ❑X No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased projecY? ❑ Yes ❑X No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed betow for your project (check all that apply):
❑ Wetlands ❑X Streams—tributaries ❑ Buffers ❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland Impacts proposed on the site, then complete this questian for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of impact Type of weBand Forested Type of jurisdiction Area of
number Corps (404,10) or impact
Permanent (P) or DWQ (401, other) (acres)
Tem ora T
W7 - Choose one Choose one Yes/No -
�/yZ - Choose one Choose one Yes/No -
�/y3 - Choose one Choose one Yes/No -
y�/q - Choose one Choose one Yes/No -
�/�I$ - Choose one Choose one YeslNo -
yyg - Choose one Choose one Yes/No -
2g. Total Wetland Impacts: 0
2h. Comments:
3. Stream Impacts
If there are perennial or intertnittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial (PER) or Type of Average Impact
number intermittent (INT)7 jurisdiction stream length
Permanent (P) or width (linear
Temporery (T) (feet) feet)
S1 T Fill MudtlyCreek PER Corps 15 10
$2 P SNabilization Muddy Creek PER Corps 15 115
S3 - Choose one - -
S4 - Choose one - -
S5 - Choose one - -
S6 - Choose one - -
3h. Total stream and tributary impacts 125
3i. Comments:
Page 4 of 10
PCN Form — Version 1.4 January 2009
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, Vibutaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individuall list all o en water im acts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number (if applicable) Type of impact Waterbody Area of impact (acres)
Permanent (P) or �ype
Tem ora T
01 - Choose one Choose
02 - Choose one Choose
03 - Choose one Choose
04 - Choose one Choose
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. Sc. Sd. 5e.
Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond (acres)
Flooded Filled Excavated Flooded Filled Excavated
p1 Choose one
p2 Choose one
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required? � Yes � No If yes, permit ID no:
5i. Expected pond surface area (acres):
S. Size of pond watershed (acres):
Sk. 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 impac[s
below. If an im acts re uire miti ation, then ou MUST fill out Section D of this form.
6a. Project is in which protected basin? ❑ Neuse � Tar-Pamlico � Catawba � Randleman ❑ Other:
6b. 6c. 6d. 6e. 6f. 6g.
Buffer Impact Reason for impact Stream name Buffer Zone 7 Zone 2
number— mitigation impact impact
Pertnanent(P)or required? (square (square
Tem ora T feet feet
61 - Yes/No
62 - Yes/No
83 - Yes/No
84 - Yes/No
65 - Yes/No
B6 - Yes/No
6h. Total Buffer Impacts:
6i. Comments:
rage o or t u
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts In designing project.
The proposed project repairs an unsate road shoulder using gabion baskels and will also prevent future erosion of the roadway and sheam channel.
The outdated terracotta pipes will be replaced with reinforced concrete pipes. Accumulated sediment will be removed from the ditch line and the area
will be replanted with gress, as it is currently.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Erosion and sedimentatlon control will be installed prlor to construction. Water will be diverted around the work area to prevent downstream
sedimentation. Best Management Practices will be used to protect surface waters, staging of equipment in or adjacent to waters of the US will be
restricted. A pre-consWction meeting with the Division Environmental stafFwill be held prior to construction along with continued coordinatlon
throu9hout lhe IHe of the project
2. Com ensato Miti ation for Im acts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ❑ Yes X❑ No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ❑ DWQ ❑ Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this
project? ❑ Payment to in-lieu fee program
❑ Permittee Responsible Mitigation
3. Com lete if Usin a Miti ation Bank
3a. Name of Mitigation Bank:
Type: Choose one Quantity:
3b. Credits Purchased (attach receipt and ietter) Type: Choose one 4uantity:
Type: Choose one Quantity:
3c. Comments:
4. Com lete if Makin a Pa ment to In-lieu Fee Pro ram
4a. Approval letter from in-lieu fee program is attached. ❑ Yes
4b. Stream mitigation requested: linearfeet
4c. If using stream mitigation, stream tempereture: Choose one
4d. Buffer mitigation requested (DWQ oniy): square feet
4e. Riparian weUand mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form — Version 1.4 January 2009
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian bufferthat requires � Yes ❑ No
buffer mitigation?
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 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:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 7 of 10
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified � Yes ❑X No
within one of the NC Ri arian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes � No
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project? p o�,
2b. Does this ro'ect re uire a Stortnwater Mana ement Plan? ❑ Yes ❑x No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
NCDOT is not changing the imperviousness at this location.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stormwater Management PIan7
3. Certified Local Government Stormwater Review
3a. In which local overnmenYs'urisdiction is this ro'ect?
❑ Phase II
3b. Which of the following locally-implemented stortnwater management programs ❑ NSW
❑ USMP
apply (check all that apply): p Water Supply Watershed
� Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ❑Yes ❑ No
attached?
4. DWQ Stormwater Pro ram Review
�Coastal counties •
❑HQW
4a. Which ofthe following state-implemented stormwater management programs apply �ORW
(check all that apply): ❑Session Law 2006-246
❑Other:
4b. Has the approved Stortnwater Management Plan with proof of approval been ❑ Yes ❑ No
attached?
5. DWQ 401 Unit Stormwater Review
Sa. Does the Stormwater Management Pla� meet the appropriate requirements? ❑ Yes � No
5b. Have all of the 401 Unit submittal requirements been met? ❑ Yes � No
Page S of 10
PCN Form — Version 1.4 January 2009
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the 0 Yes ❑ No
use of public (federal/state) Iand7
1 b. If you answered "yes° to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ❑ Yes ❑X No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes' to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ❑ Yes ❑ No
Camments:
2. �olations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or WeUand Standards, ❑Yes ❑X No
or Riparian Buffer Rules (15A NCAC 26 .0200)?
2b. Is this an after-the-fact permit application? ❑Yes ❑X No
2c. If you answered "yes' to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in � Yes � No
additional development, which could impact nearby downstream watar quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no;' provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. 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 facility.
Page 9 of 10
PCN Form — Version 1.4 January 2009
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or � Yes ❑ No
habitat?
5b. Have you checked with the USFWS conceming Endangered Species Act 0 Yes ❑ No
impacts?
Sc. If yes, indicate the USFWS Field Office you have contacted. Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC NaWral Heritage data and use of the Northern Long-Eared Bat 4(d)Rule Streamlined Consultation Form
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes ❑X No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. �II this project occur in or near an area that the state, federal or tribal
govemments have designated as having historic or cultural preservation � yes ❑ No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to detertnine whether your site would Impact historic or archeological resources?
North Carolina State Historic Preservation Oifice GIS Service. See attached'No Survey Required' forms from NCDOT Culturel Resources for Historic
Archifficture and Archaeology.
8. Flood Zone Designation (Corps Requirement)
Sa. Wiil this project occur in a FEMA-designated 100-year floodplain? ❑ Yes ❑X No
Sb. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
FEMA FIRM maps
Stephanie Braquet � 4/10l2017
ApplicanUAgent's Printed Name pplicanNAgenY ignature Date
(Agen signature Is valid if an authorization
tter finm the a Iic t is rovided.
Page 10 of 10
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Piorthem Long-Eared Bat 4(dl Rule Strea lined onc��ltation Form
Federal agencies should use this form for the optional streamlined consultation framework for the northern long-eared
bat (NLEB). This framework allows federal agencies to rely upon the U.S. Fish and Wildlife Service's (USFWS)
January 5, 2016, intra-Service Programmatic Biological Opinion (BO) on the fma14(d) rule for the NLEB for section
7(a)(2) compliance by: (1) notifying the USFWS that an action agency will use the streamlined framework; (2)
describing the pmject with sufficient detail to support the required determinarion; and (3) enabling the USFWS to track
effects and determine if reinitiation 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 or if the
USFWS has concurred in writing with an agency's deternunation that a proposed action may ai%ct, but is not likely to
adversely affect the NLEB (i.e., the standard informal consultation process). Acrions that may cause prohibited
incidental take require separate formal consultation. Providing this information dces not address section 7(a)(2)
compliance for any other listed species.
Information to Determine 4(d) Rule Compliance: YES NO
1. Does the project occur wholly outside of the WNS Zone�? ❑ x
2. Have you contacted the appropriate agencyZ to determine if your project is near X �
known hibernacula or matemity roost trees?
3. Could the project disturb hibernating NLEBs in a known hibernaculum? ❑ x
4. Could the project alter the entrance or interior environment of a known � X
hibernaculum?
5. Does the project remove any trees within 0.25 miles of a known hibernaculum at � X
any time of year?
6. Would the project cut or desiroy known occupied matemity roost trees, or any
other trees within a 150-foot radius from the maternity roost tree from June 1 � x
throu Jul 31.
You are eligible to use this form if you have answered yes to question #1 �yes to question #2 �],no to questions 3,
4, 5 and 6. The remainder of the form will be used by the USFWS to track our assumptions in the BO.
Agency and Applicant� (Name, Email, Phone No.): NCDOT Division
Stephanie Braquet, scbraquet a ncdot.�ov, (336)747-7800 Division 9
Proiect Name: Forsyth County Main Street (Bethania) SR 1611
Project Location (include coordinates if known): 36.1902 N-803376 W
Basic Project Description (provide narrative below ar attach additional informadon): NCDOT will add 105
linear feet of gabion baskets to the streambank to repair and prevent scour.
2 See http://www.fws.gov/midwest/endangered/mammals/nleb/nhisites.html
3 If applicable - only needed for fedenl actions with applicants (e.g., for a permit, etc.) who are party to the consultation.
General Project Information YES NO
Aeencv Deternvnation:
By signing this form, the action agency deternunes that this project may affect the NLEB, but that any
resulring incidental take of the NLEB is not prohibited by the final4(d) rule.
If the USFWS does not respond within 30 days from submittal of this form, the action agency may presume
that its determination is informed by the best available information and that its project responsibilities under
7(a)(2) with respect to the NLEB aze fixlfilled through the USFWS January 5, 2016, Prograznmatic BO. T'he
action agency will update tlus detemunation annually for multi-year activities.
The action agency understands that the USFWS presumes that all 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 acrion 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.
Date Submitted: 4/10/2017
° Any activity that temporarily or permanently removes suitable forested habitat, including, but not limited 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 unknown, report the acreage as less than 0.1 acre.
6 If the activiTy includes tree clearing in June and July, also include those acreage in April to October.
Project No:
WBS No.:
Aid No:
Projed Tracking No. (Irrtn�naf Uae)
16-12-0004
UPDATE
HISTORIC ARCHICTECTURE AND LANDSCAPES
ASSESSMENT OF EFFECTS FORM
This form only pertains to Historic Architecture and Landscapes for this project. It
is not valid for Archaeological Resources. You must consult separately with the
Archaeology Group.
Federal I IXJ I'es
PROJECT INFORMATION
County: Forsyth
Document MCC
T e:
Fun�ling: State
Vo Permit NWP 3
Grading, Drainage at Intersection oF Bethania Main Street (SR 1508) and Turfwood Drive (SR
1601)
HISTORIC
n�
17:�%7�`.'/
Review of HPO quad maps, HPO GIS information, historic designations roster, and indexes was
undertaken on December 8, 2016. Based on this review, the project falls within the National
Register listed Bethania Historic District (FY8772). A No Adverse Effect on the district was
received on 7anuary 10, 2017 for the pronosed work. Stream relocation for road shoulder needed.
ASSESSMENT OF EFFECTS
Property Name: Bethania Historic District Status: National Register listed
Survey Site No.: FY8772 PIN: Multiple
Effects
❑ No Effect [� No Adverse Effect ❑ Adverse Effect
Explanntion ofEffects Determination:
Lrst oiEnvironmental Commitments:
Hi.noric A�d+imcttvr miALm�AsraprslFFL•CiSAS57iS5i1f6N'/'fom� for h/inor 7rmupormtion ProJens us Qmlffi�v/ in Ihe 3007 YroRi9��rnalic A�neenirrn.
Page 1 of 2
FHWA Intends to use the State Historic Preservation Office's concurrence as a basis for a"de
minimis" finding for the following properties, pursuant to 5ection 4(�:
SUPPORT DOCUMENTATION
�ap(s) �Previous Survey Info. ❑Photos �Correspondence ❑Design Plans
FINDING BY NCDOT AND STATE HISTORIC PRESERVATION OFFICE
Historic Architecture and Landscapes —QSSESSMENT OF EFFECTS
NCDOT Architectural Historian
State Historic Preservadon Office
Federal Agency Representative
�` �- 7
Date
�("—'�'- /
Date
Date
Hisraric Arehirecmrr nrnlLmxlrmpes F.'/%FF.(7S ASSLSSMIiN"fforn� Jm� blinar iMnapmvoriw� Pro�ecrs as Qxo/ifin/in tlm 1007 P+nR���ma�ic Ap,rcernenf.
Page 2 of 2
State Historic Preservntion Office G1S.
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Page 2 of 2
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P�rojat Tra�king No. (Gefernal Ure)
16-12-0004
HISTORIC ARCHICTECTURE AND LANDSCAPES
AS5ESSMENT OF EFFECTS FORM
This form only pertains to Historic Architecture and Landscapes for this project. It
is not valid for Archaeological Resources. You must consult separately with the
Archaeology Group.
PROJECT INFORMATION
Project No: Coun[y: Forsyth
WBSNo.: 9.203411 Document MCC
T e:
Fed. Aid No: N/A Funding: � State ❑ Federal
Federnl � Yes No Permit NWP 3
Permit s: T e s:
Proiect Descrintion:
Grading, Drainage at Intersection of Bethania Main Street (SR 1508) and Turfwood Drive (SR
1601)
SUMMARY OF
Review of HPO quad maps, HPO GIS information, historic designations roster, and indexes was
undertaken on December 8, 2016. Based on this review, the project falls within the National
Register listed Bethania Historic District (FY8772).
ASSESSMENT OF EFFECTS
Prnperty Name: Bethania Historic District Status: National Register listed
Survey Site No.: FY8772 PIN: Muitiple
Effects y.
❑ No Effect �(J No Adverse Effect ❑ Adverse Effect
i�
Exalanation oiEf%cts Determinntion:
�o AdVeSZe P�ec,�-�- �n � a,3�`'r; c c�iSknz�_
List ofEnvironmentrsl Commiiments:
Hisroric Archliecmrs mW LmiAn�upr.+ /i/9'ECTSASS(iSSM/iN7 fmni forMinor Timwponanon Projeaa m Quaffedin ihe I007 Prog�nnnnartc Ay,��ecmrm.
Page 1 of 2
FHWA Intends to use the State Historic Preservation Office's concurrence as a basis for a"de
minimis" finding for the following properties, pursuant to Section 4(�:
SUPPORT DOCUMENTATION
�Map(s) �Previous Survey Info. �Photos �Correspondence ❑Design Plans
FINDING BY NCDOT AND STATE HISTORIC PRESERVATION OFFICE
Historic Architecture and Landscapes — A�SESSMENT OF EFFECTS
NCDOT Architectural Historian
Date
�•�o•t�-
State Historic Preservation Office Representative — Date
Federal Agency Representative
Date
Hismrlc Ars�hitrcmrc mW Lanah��nprslil'FT:(7S.9SSF.'SSA/F.'N7'fom�/orMinor'/'rmuponoiion P�nJrca nrO�m(fed in tlm d007Rrogmnunmia AR�emem.
Page 2 of 2
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FORSYTH COU11tTY
LOCATIOX: IN'I&RSEC770N OF BE'/'�AN/A MAIN ST (1508)
AND 7TJRFWOOD DR (]601)
TYPE OF WORK: GRADING, DRAINAGE
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Praject Tracking No.
16-12-0004
o�€?�,p., NO ARCHAEOLOGICAL SURVEY REQUIRED FORM ���A�
:�
�y,�-� �; This form only pertains to ARCHAEOLOGICAL RESOURCES for this project. It is not d; r m�
a,� o�� valid for Historic Architecture and Landscapes. You must consult separately with the �` ��, e2�
��nI% Historic Architecture and Landscapes Group. ��J ;_p�i
PROJECT INFORMATION
Project No:
WBS No:
Federal Aid No:
9.203411
Federad Permit Required?
County:
Document:
Funding:
� Yes ❑ No
Forsyth
State Minimum Criteria Checklist
� State ❑ Federal
Permit Type: NWP 3
Project DescriptBon:
Grade and drain SR 1611 (Bethania Main St.) at Turfwood Dr. in Forsyth County. Area of
Potential Effects (A.P.E.) is approximately 48 meters (158 ft.) long. Design plans (provided)
show the project includes the repair of a drainage ditch along the east side of SR 1611.
Improvements within the existing right of way. State-funded; will require Federal permits; no
easements required.
SUMMARY OF CULTURAL RESOURCES REVIEW
Brief description of revdew activities, resu[ts of review, and conclusions:
The review included an examination of a topographic map, an aerial photograph, and listings of
previously recorded sites, previous azchaeological surveys, and previous environmental reviews
at the Office of State Archaeology (O.S.A.). The road and ditch aze oriented approximately
north-south.
The topographic map (Rural Hall, N.C.) shows the ditch is located in a drainage valley at the
base of a sloped ridge toe. The floodplain of Muddy Creek is located a short distance west. The
A.P.E. is depicted as wooded (in 1987). There is an unoccupied structure shown on the west side
of the road in the vicinity of the A.P.E. Drainage valleys have a low potential for azchaeological
sites.
T'he aerial photograph shows the A.P.E. is a cleared residential yard along the east side of SR
1611. There is a driveway at the south end.
A review of information at the O.S.A. shows there are no previously recorded archaeological
sites within or adjacent to the A.P.E. Sites 31FY703 and 31FY704 are located west of the
A.P.E., on the floodplain along the west side of Muddy Creek. The A.P.E. has not been
previously surveyed for azchaeological sites. The A.P.E. is not within any areas that have been
reviewed by the State Historic Preservation Office (HPO).
Brief Explanation of why the available information provides a reliable basu for reasonably
predicting that there are no unident fed historic properties in the APE:
There are no previously recorded sites within the A.P.E. The A.P.E. is a ditch within the existing
right of way on the east side of the road. The landform in the A.P.E. has a low potential for
"NoARCFLIEOLOGYSURVEYItEQUIRED "Jo'm forMmor7Yarepormrion ProJects asOuolified in rhe 10l5 Programmonc Agreement
1 of 7
azchaeological sites.
SUPPORT DOCUMENTATION
See attached: � Map(s) ❑ Previous Survey Info
❑ Photocopy of County Survey Notes
FINDING BY NCDOT ARCHAEOLOGIST
NO ARCHAEOLOGYSURVEYREQUIRED
Caleb Smith
NCDOT ARCHAEOLOGIST II
Project Tracking Na.
16-12-0004
❑ Photos ❑Correspondence
Other:
2/14/2017
Date
"NoARCFL4EOLOGYSURVEYR&QUlR&D"jorm forMiirorTmnsporration Projecfs as Qual�ed in the 20l5 Progrummatic Agreemwt.
2of7
"No ARCHAEOfAJGY S(/R VEY REgU1RE'O"furm. fnr M+nor Transpormrion ProjecGs as Qva( fed in rhe 2015 Progrommaric Agreemenr.
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VICINITY MAP
LEGEND
EAISrfNG ECGE OF PwEUENt_........_._______..
EXISTfNG BMx OF NRB____________._......... ----
ENISifNG EWE OF TRAVELWAY
EXIST(NGCONCREI£ ISLhNO _. ._---
PFOPOS£O EGGE OF PAVEMEN! ... ___
PROPOSEO BMK OF NRB __
PROPOSEO L0.NE L1NE5 -
lN�TESTFIPING WILL BE ORM4N pP BY iR/6FIC SEFVRE51
PROPOSEO LONCRETE IS(PND . __ __
£XISTIIlGF)GHT-0FWNCINE. ... ___-�-----��
PROPoSEO RlGH��OFW4Y (INE .... __�
EXISTfNGPROPERTYCME ...._ �_ _
PROPGJEO EAS£MEM LONSTRULTIOK. .. .. — E-
PRO!'OSEO TO£ OF 5[OPE ___ _ .. _ _ _
PROPoSED Cl/i/FICL SLOPE ... ____ ..
UTILITIES & STRUCTURES
U/ILITY & 5)GNAL Pof£ .............._.._____ __ _ _ _ _ •
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GRAPHIC SCALES DESIGN DATA PROJECT LENGTH
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