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Home My WebLink About20170429 Ver 1_NW-13 permit application_20170410ROY COOPER GOVERNOR yT)ATEw + � 1 �� ,, � ��a ��h wx 1?C. 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 T � r o < 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? 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Is53 / ».� / il - � L �"=f _ .``� L . - �. f/ I^l i / _ \,�� 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. Hutm�¢ �lirdirecuu�e mrAlaualscupes S1f21%fY /t1i0U!/t/iDJw�m/a�Adinor Transpormiiou Prolectc as Quo/'freJ iu qre 200] /'rngr'mnnmlir Agreenwur. Page 2 of 2 I' I P/ Sra 13�20%�-L- p = f0'S4'392'lRTI o = a;r�i� L = 2992/ i = 130(b' R = 136131' K 1 i HLEE�' S'�aORr21S nNn �USB"�vD. JOHN i1��RK M'JGRIS ;qEES '�E 1822 PG 3i89 — � Dl, E F�;:c"rvr-4.r'i.�+r'''�s�.r '_ � �� / 5 . f.�. — � Tft6�- LI' iE� � . ,� '.-_ 'xis .�. airi � �r 9006 � __. _. �.. . _ / . Gl � ..— — �_' S �:.... - � —, . �, — _ 24 ��_ _ — —�-'-- ��q¢ �� _ � f I/ (jp5 � � — �� P� ta.l0a "r l— ` �~ G � ' _ ,ti�. — '.-� �—�—..� y .. W J�� C� o � T � 3 C `. - r^"ta5� � �� 5EE i a�� • � m �— 8' / . , - m1^2�-+k��v OE � �+ _ +J H � � � � f—` � � �- —` W _--�MNN SL(SP 161U ��— �__.y� 1,�� o /, GRP55 i � � BSi�W"6 .. � � \Aa o � CS �— E �� .� " 4EE OEi>� 1�E9� \� a p I —�� W T37 H��a FORN- �� .:. - sEE oETaa ^�_ "�. man5s � ��,c � a.A I "�� -. � . �,J�� Fp;� '1 1 € C3 � —� ��-:,, l�-✓ �MPAC4� 1 al � � � \ ` �� 44\P�IE�t S(REPM , _ � 1 � ^ i x.r ,,: �F o� � 1 � N , � ,�- � U` � ma ;4EE5 GRASS I '�{ rv � � � �ise ac�� . Sro. ua03?e� ti0 �v oc tEMPOpn0.� STREaM .l.F' �\ � i911 p11� I ,�. � � O� �i 5� i..i� ��.^T4.�r�� `� \,�, •� 1, Cj 4�I ��` ',�, 1 bo.ao� c f.OB�RT E P^.UST � � . . _. - �8 2975 PG �C3 . ot.� ,�,: ;' o o.� ��f- G. ��_ � US='�HpG��' ��1 � �c i 2 FG -.� . PAUI CAROIti � �� 75� 't � u4� � � ` ��5� �� 3 . i 1 � 1 � OEPARIM£Ni OF )R.iNSPORTAnON �Q ��Q C��i/��l�C .iC:liE 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 0 3 � H � � ; ,�r�; ,". �- ti; t.a�,�� w'�-�=�-.,� � � . VICINITY �YIAP � LEGEND � wn@..�� ..�.�y..,�4.�_ . r� �_ �EfEi�H nLL. .. � � SIG�M W � O W f(t �i`uW� � r va� �Iv[ ON� CiillPfllC $CIILC•$ � o xo TIT�77� � � � PIwNS �Q T�i�� 3 TV0.0FILE �HONZON{puT 0 DESIGN DATA xTs 5'If'r�'S'lE �F N�ddT1H �:�ll3�]L][Nt� II9II$✓ISI�N �]F 2-IIgis]FIW.�'�S FORSYTH COU11tTY LOCATIOX: IN'I&RSEC770N OF BE'/'�AN/A MAIN ST (1508) AND 7TJRFWOOD DR (]601) TYPE OF WORK: GRADING, DRAINAGE .,.� � �,ni PROJEC: L6NGiX 0.05 MILES �s MOe N� 3R7h1ENT OF IRANSPOR7A3 DIV. 9 /DISTRICT 77 COUMP FORSriN 10/il/2016 NTS .i�»—i.4 vx�e�'�m�v W'�'�'��` IV2V2016 Ni5 PUN S!'Al£..WI RR�IDif�YRVIV msrxlo evcuaen OMS/ON yPAYFIL fNGMFFR _. � MAIN EROSIONCONTROLLEGEND no..i..e.nert�nox, ,� „ .oa.,� e�@,.�a .00w.a ,�,,.K< <oo.�e ..� R�a��.�..E�.o�,s..,. � �. ,�.o.,x..,a..o , � ,�,.a� ..� ..a ,.... � E� �. are.swnvee aI¢ .w.o:r�nsOo�eXw.nE.wuor.euu � i- n:.o- rt++ow.A. aa. smrwr o�. i.�� mm re�,.o.w. aor. .: o.. r.o �� n ur«� . � moi.e�r �� E.n. b� an.oi RwaeOpNe h�'[p[E�fn �nc • � �95.W IfYi0Aµ�5Xtt1 lh: M[F IRE B I u w�rt¢ � ,4 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. 3 of 7 -' - �r. . ,r� , . . � . . . .. .. . ._. ,;� __, . . . . . �, ��t � _ '_.. __ . . � � . . - ��;:�".' y, .., . �. , �%�� \ F .i • � I ' - i`!^. � ��'�5' \ � � � jt�. ._. . F - � . 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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£ .............._.._____ __ _ _ _ _ • PpVER PO(£ __ .... _____ TE(EPHONE PEOESTPL ..... ________ GN"W1RE ..... ____- .__;<. SIGxa[ BOx _ ____ ____-_""_..._...._.._'""'____ _-. SANISEWER AfM'HO!£......___..__._ _ __ _ __ _ ___ Sru/I.SEwER ClEaxOUL_ .....�� _ _ ..........""""_"'"""''"'"_ _".. . WATER METEF........_..__________. ...._p WnTER vaLvf .__ ..... ____ FIRE m'OR4Ni___ ___ .__P. GAS MfT£R ___ _____ .____ G45 V4(VE .... ..........________ CATCH B0.51N & OI"5........... .............. GuaRORaft________._________._........."""__�_ r x v � i FENLE._. ......_..........._............_. '—' St0£WOCK ................................. . .. TFEE_..........__..__.._ _ _ _ _ __ ___ __________'_ NTS � 11 f'il 1L 1Le �11� A�' �� ll 1C7L �a`il��1Le1LA@� L� �� 1.i' ��`s��.��'� FORSYTH CO U1�TY LOCATION: I1�TERSECTIOIV OF BETHANIA MA71Y ST (1611) AND TURFWOOD DR (lYSR) TYPE OF WORK GRADIIVG, DRAl1�AGE �� — � � . .-..✓`v'4��v^�J'. .� r.'� �� -v� �=--�- �� --- •�• BETHANIA MAIN S 1 EROSION CONTROL LEGEND ROCM IN�ET PROtEC➢ON: B%q ivPEA ......................._...._......._....._.. G� OR dJ, �� 89G02 irPEB_....._......_...__...._......._......._._B U OF B: 1 B%W ixPE0....._...._....__._._.._...._..._C � OP C � 991.q ROCMPIPEINLE1PPOiECiiDN.._.__ L✓q i..,, NiA PIPEOOiLETENEFGY�ISSIPPiOR.. 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