20170497 Ver 1_SR 1127_SS4914 CJ_401 Certif App_Henderson_20170424

Carpenter,Kristi
From: McHenry, David G
Sent: Monday, April 24, 2017 2:09 PM
To: Barnett, Kevin; Chapman, Amy; Carpenter,Kristi; Whitehead, Reid O
Subject: NCDOT 401 Cert Request for SR 1127 Guardrail Project, Henderson
County
Attachments: SR 1127_SS4914 CJ_401 Certif App_Henderson.pdf
Follow Up Flag: Follow up
Flag Status: Completed
Folks,
Please accept this 401 Cert request for the subject project. It has been a long time since
I reviewed a stand-alone 401 application in WARO, so I I hope I included enough
information for your review. Please let me know if not or if you have any questions.
Thanks for your assistance with this.
Dave McHenry
Environmental Officer
NC Department of Transportation/Division 14
828 586 2141 office
dqmchenrv(a�ncdot.gov
253 Webster Road
Sylva, NC 28779
_ �f �� �`�:
� � i , i,? ; _
�tiw
r+.
, +. .� .:'..'
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Email correspondence to and from this sender is subject to the N.C. Public Records Law and may be disclosed to third
parties.

ROY COOPER
GOVERNOR
tae STA�Tmo,�
�.� "" °m
Ty
� � � _ -�.
��'�, +°a�am° d�
os.m,M,��
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Apri124, 2017
Mr. Kevin Barnett
NC Department of Environmental Quality, Division of Water Resources
Asheville Regional Office
2090 US 70 Highway
Swannanoa, NC 28778
Subject: General Water Quality Certification 4088 Application
SR 1127 Crab Creek Road Guardrail Project
Culvert Extension in iJT Mud Creek
Henderson County, North Carolina
TIP No: SS-4914CJ, WBS Element No. 44730.3.1
Dear Mr. Barnett:
7AMES H. TROGDON, III
SECRETARY
The North Carolina Department of Transportation (NCDOT) is proposing to extend by 10 feet a
40 foot long culvert in an unnamed tributary to Mud Creek to facilitate installation of guardrail
along SR 1127 (Crab Creek Road) in Henderson County. The road shoulder at the culvert site is
too narrow for guardrail posts. This project is covered under Nationwide Permit 14, but the site is
not in a trout watershed identified by the NC Wildlife Resources Commission and the work is
consistent with the other exemptions from U.S.Army Corps of Engineers noti�cation in the 2017-
2022 Final Regional Conditions.
Please find enclosed a PCN application, maps, photographs with mark-ups, and other supporting
project information.
The proposed work will not affect wetlands or habitats that could support federally protected
species. Tree clearing, bridge demolition, and percussive activity will not be required, so there
will be no effect on species of bats.
NCDOT best management practices will be used to minimize and control sedimentation and
erosion. The road shoulders will be quickly stabilized after construction to prevent erosion. We
have applied for dewatering of the culvert, as needed, to avoid excavation in the wet.
Impacts to Waters of the United States
The UT Mud Creek (DWQ Class: C) is not shown on the USGS topographic map as a perennial
stream, but it has a well-defined channel approximately 2' wide with a substrate of gravel and
MailingAddress: Telephone: [phone] Location:
NC DEPARTMENT OF TRANSPORTATION Fac: (828)5861}043 NC DEPARTMENT OF TRANSPORTATION
Division 14 CustomerService: 1-877-368-4968 Division 14
253 Webster Road 253 Webster Road
Sylva, North Carolina 28779 Website: www.ncdot.¢ov Syiva, North Carolina 28779

sand. It flows downstream about 250 feet to Mud Creek, which then flows about 15 miles to the
French Broad River (HUC 06010105). The French Broad River meets the definition of a
Traditional Navigable Water. For these reasons, we believe the LTT Mud Creek is a Relatively
Permanent Water and is under the jurisdiction of the U. S. Army Corps of Engineers. Extension
of the culvert will impact waters of the United States as follows.
Site No. E�sting Condition Proposed Condition Net
Station Im acts
Site 1 40' x 24" corrugated 50' x 24" corrugated metal pipe 10'
metal pipe (10' Extension)
Site lA free-flowing stream impervious dike and temporary flow 60'
diversion
Permits Requested
NCDOT is hereby requesting certification under Section 401 of the Clean Water Act to proceed
with the construction project outlined above. Please contact me at [phone] if you have
any questions or need additional information. Your prompt review and consideration of this
request will be greatly appreciated.
S16ocuSig1ld by:
L/ �-„ � ��
���3�c��e�sry
Division 14 Environmental Officer
Enclosures
cc: Ms. Amy Chapman, Division of Water Resources, DEQ, Raleigh
Ms. Kristie Lynn Carpenter, Division of Water Resources, DEQ, Raleigh
Mr. Reid Whitehead, Roadside Environmental Field Operations Engineer, NCDOT

O�O� W AT �9�G
� �
> �,
O T
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. A licant Information
1. Processing
1a. Type(s) of approval sought from the
Corps: � Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ❑ Yes � No
1 d. Type(s) of approval sought from the DWQ (check all that apply): DWQ GC 4088
� 401 Water Quality Certification — Regular ❑ 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 401 For the record only for Corps Permit:
because written approval is not required? Certification:
❑ Yes � No � Yes ❑ No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation � Yes � No
of impacts? If so, attach the acceptance letter from mitigation bank 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 Concern (AEC)? ❑ Yes � No
2. Project Information
2a. Name of project: SR 1127 Crab Creek Road Guardrail
2b. County: Henderson
2c. Nearest municipality / town: Hendersonville
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or State SS-4914CJ, 44730.3.1
Project No:
3. Owner Information
3a. Name(s) on Recorded Deed: North Carolina Department of Transportation
3b. Deed Book and Page No. N/A
3c. Responsible Party (for LLC if Dave McHenry, Division 14 Environmental Officer
applicable):
3d. Street address: 253 Webster Road
3e. City, state, zip: Sylva, NC 28779
3f. Telephone no.: 828-586-2141
3g. Fax no.: 828-586-4043
3h. Email address: [e-mail]
Page 1 of 10
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is: ❑ Agent ❑ Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: N/A
5b. Business name N/A
(if applicable):
5c. Street address: N/A
5d. City, state, zip: N/A
5e. Telephone no.: N/A
5f. Fax no.: N/A
5g. Email address: N/A
Page 2 of 10 PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): N/A
1 b. Site coordinates (in decimal degrees): Latitude:35.2474 Longitude: -82.5344 (��.������)
(-DD.DDDDDD)
1 c. Property size: N/A acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Mud Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: C
2c. River basin: French Broad
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 general landscape is a single-family residential with scattered small farms.
3b. List the total estimated acreage of all existing wetlands on the property:
N/A
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
75
3d. Explain the purpose of the proposed project:
The purpose of the project is to extend by 10' a 40-foot 24" corrugated metal pipe under SR 1127 and in a UT to Mud
Creek in order to gain sufficient shoulder width for guardrail posts.
3e. Describe the overall project in detail, including the type of equipment to be used:
Erosion and sedimentation control measures will be installed. The stream bed will be temporarily dewatered as needed
in the extension area and the streambed excavated before installing the culvert length. Heavy equipment, water pumps,
sandbags, diversion pipe and various hand tools will be used to accomplish the work.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past? ❑ Yes � No ❑ Unknown
Comments: N/A
4b. If the Corps made the jurisdictional determination, what type
of determination was made? ❑ Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: N/A
Name (if known): N/A Other: N/A
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
N/A
5. Project History
5a. Have permits or certifications been requested or obtained for � Yes � 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 project? ❑ Yes � No
6b. If yes, explain.
N/A
C. Proposed Impacts Inventory
Page 3 of 10 PCN Form — Version 1.3 December 10, 2008 Version

1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
❑ Wetlands � Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If 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 of jurisdiction
number — Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ — non-404, other) (acres)
Temporary (T)
W1 ❑ P❑ T N/A N/A ❑ Yes ❑ Corps N/A
❑ No ❑ DWQ
W2 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W3 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W4 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W5 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W6 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
2g. Total wetland impacts
2h. Comments: N/A
3. Stream Impacts
If there are perennial or intermittent 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 Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ — non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 � P❑ T Culvert Extension UT Mud Creek � PER � Corps 2 10
❑ INT � DWQ
S1A ❑ P� T Temp. Flow UT Mud Creek � PER � Corps 2 60
diversion ❑ INT � DWQ
S2 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S3 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S4 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S5 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
3h.
Total Permanent Stream Impact for Culvert 10'
Total Temporary Stream Impact for Impervious Dike and Flow Diversion 60'
3i. Comments:
Page 4 of 10 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 waterbody
impact number- (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P)
or Tem ora T
01 ❑ P❑ T N/A N/A N/A N/A
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
4f. Total open water impacts N/A
4g. Comments: N/A
5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose of (acres)
number pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1 N/A N/A N/A N/A N/A N/A N/A N/A
P2
5f. Total N/A N/A N/A N/A N/A N/A N/A
5g. Comments: N/A
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no: N/A
5i. Expected pond surface area (acres): N/A
5j. Size of pond watershed (acres): N/A
5k. Method of construction: N/A
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 im acts re uire miti ation, then ou MUST fill out Section D of this form.
6a.
❑ Neuse ❑ Tar-Pamlico ❑ Other:
Project is in which protected basin? ❑ Catawba ❑ Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number- Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) for Stream name mitigation (square feet) (square feet)
or Tem ora T im act re uired?
B1 ❑ P❑ T N/A N/A � Nos N/A N/A
B2 ❑P❑T ❑Yes
❑ No
63 ❑P❑T ❑Yes
❑ No
6h. Total buffer impacts N/A N/A
6i. Comments: N/A
Page 5 of 10 PCN Form - Version 1.3 December 10, 2008 Version

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 minimum culvert length is being installed to gain the needed shoulder width while ensuring road fill stability.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
A flow diversion will be used as needed to avoid excavation in the wet. Disturbed soils will be quickly stabilized with seed and
matting around the culvert outlet.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ❑ Yes � 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. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank: N/A
3b. Credits Purchased (attach receipt and letter) Type N/A Quantity N/A
3c. Comments: N/A
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ❑ Yes
4b. Stream mitigation requested:
4c. If using stream mitigation, stream temperature: ❑ warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only): N/A square feet
4e. Riparian wetland mitigation requested: N/A acres
4f. Non-riparian wetland mitigation requested: N/A acres
4g. Coastal (tidal) wetland mitigation requested: N/A acres
4h. Comments: N/A
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.
N/A
Page 6 of 10 PCN Form — Version 1.3 December 10, 2008 Version

6. Buffer 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 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 N/A N/A 3(2 for Catawba) N/A
Zone 2 1.5
6f. Total buffer mitigation required: N/A
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).
N/A
6h. Comments: N/A
Page 7 of 10 PCN Form — Version 1.3 December 10, 2008 Version

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 � No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
Comments: N/A
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? N/A %
2b. Does this project require a Stormwater Management Plan? � Yes ❑ No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: N/A
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
The plan is covered under the NCDOT General Stormwater Permit No. NCS000250 . Additional impervious surface will
not be added for the project. Stormwater will continue diffuse flow down vegetated road shoulder.
2e. Who will be responsible for the review of the Stormwater Management Plan? ❑ Certified Local Government
NCDOT ❑ DWQ Stormwater Program
� DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local governmenYs jurisdiction is this project? N/A
❑ Phase II
3b. Which of the following locally-implemented stormwater management programs ❑ NSW
apply (check all that apply): ❑ USMP
❑ 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 of the following state-implemented stormwater management programs apply � ORW
(check all that apply): ❑ Session Law 2006-246
❑ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ❑ Yes ❑ No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ❑ Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met? ❑ Yes ❑ No
Page 8 of 10 PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the � Yes ❑ No
use of public (federal/state) land?
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 � 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
Comments: N/A
2. Violations (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 Wetland Standards, ❑ Yes � No
or Riparian Buffer Rules (15A NCAC 26 .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, provide an explanation of the violation(s): N/A
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 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.
The road is not being upgraded. Rather, the project will only involve adding guardrail to an existing road. The secondary
and cumulative impacts from this routine construction project are expected to be insignificant.
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.
N/A
Page 9 of 10 PCN Form — Version 1.3 December 10, 2008 Version

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 concerning Endangered Species Act � Yes � No
impacts?
❑ Raleigh
5c. 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?
North Carolina Natural Heritage Program Database and site visits during and after the field scoping process.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project 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 would impact Essential Fish Habitat?
N/A--There are no marine or estuarine habitat within the Blue Ridge Physiographic Province
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments 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 determine whether your site would impact historic or archeological resources?
This project will be constructed all within existing DOT r/w which is disturbed. According to the NC SHPO website there
are no historic properties in the project vicinity.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ❑ Yes � No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? NC Floodplain Mapping Program
DocuSigned by:
Dave McHenry ��� �� 4/24/2017
Division Environmental Officer 86673FBE42E5415...
Applicant/AgenYs Signature Date
Applicant/Agent's Printed Name (AgenYs signature is valid only if an authorization letter from the applicant
is provided.)
Page 10 of 10 PCN Form — Version 1.3 December 10, 2008 Version

082.550 000° W 082.533 333° W 082.516 666° W
y.i � —�� ;�� � �Q� _ — ,r`",�, _ � '-_, J _ •���,"'"' ,�— `; � ` _ .' ,V ��! �d
t_., - ~'"_��-; h-'� �,, � � � ! - � _ � „ ' /� , �. - t � �� -� _ _ �; a� _ .
�_ ��. ' \ y� � � . ��.�� � - , � A _ /�J a .-+_ 1r� / � ti ,
�- `� �� � `i u y���, , �'r'
- , , :� �.� J � _ , � � � ; i � ,: ,r� i � � �� , , ,.�� __ , _� , �, ;, ,
� - � �_ `\� _ �� �� 1 7 � j '� �,, . � a
Z - `: � ( a i`+ ' � � !' ik s � � { � i '✓/ /�, �% f � �i r y � ! ,, , ` �..' ��-- �-`- `-� � J �� z
_ _y , - �� \� '��. __ �. ��� �Vf � � ,� � . �� :'p I- � .
� �, � ; . �. � y �` - 7.Y1 /} (,' �_ `. ��. � , � ' \ ik- /' 4,�?j� ��,^ �o
c0 - 1 � � ��}� ' �' / � i �� P i fi _ h y, c0
Cp . �� 4. - --- V� - �i. �� .\/` ! /."/_ - - Y! i"J/! �!°a (p
� I ;� � . '+'„-.--s- - \' � �y � y r v . } ' 1 P J �. (D
tn - � � � � _ � i r � � , f � � � �J,� � � � - i _ r � '' r � � - � � � � � `� � co
N � u� �t�l �. \ " � -/' I ` � � � �. . 0� ' I � N
� ��, � � -`74pn �' �� � � ' � '1 -i l � � "� J - � l�� 4.�' ;/ ' �� — uj
M -` � �: . ,7 \� � - ��� � I �` �' �' \� 1,1� / �" �� N'! ', M
�`' "� � � � �� � ~ ; - -�/ ���+, i �� i� � � b�erCF� 8�3'i,r ' - ~\ : \� � � � � � � ��
` f,--'=��!, - � I �� r, �` f`�� 1 �eld Ca K����, � �/'� ���
`_3 °�-�. - �\i� �1 �� I`_`�� ``� � �\ ✓. ��� '� '.., � �,�"���..�\y � ,:7.'1, bN� �,J. ���`�_1�/'`'
j Y/ �` � '� \' � I �: .J ��%A1� �� /� ,:� � ` ; � �I � � / � / S
� � / � �� : r � �� ' � � �.' N �i � � �� :ti J � ,, �, d , � ��:'
+-t -' � � � ��.- �11ar�s -� � � i' ' �^, � 2 � 1 �-_ � � � Cai+aP� Kanusa : � J ♦ -k. ; �' � '�'`�; / �
-� r � � --��, ^� / ' fi� i r I s' - �'� � -� .
� , � �� �i � L115 H I � ���� L — ��:� � �'ll ' �� � ,�• � � � J _„ � �� l� ,y�, I� _.�., `_ ✓n � �i '_v
� °( , •, � �_, ' �" � � /� /� ( �� �a,� o : � _ - � �'�, La Ci1a� f!1 :s'� � ,�' � �� �1
� 'O fl ��^ I
I } i ', � - �'/ ` � , ` `-� 1,,, �/,,� -'"..1� �" � •--� + , ! ,�l � `�_
� � � l� f �, �•� .
��� �` �lac� acl�-- _ "� ,� ; ?, r f `", - _� '� �y ✓ �: , � l,�� � - .-e-{ f i 1; ,t � `�(''� `1��� i � 'L:�
� � �`. I�buiit�,IlfY �Ard�a 7 �� � /f�✓7� - �j' � � % ��� � �' )��� `('^ _ � V�� ����1 �C�l, �\��� ���
,� �,v �, i� .�'rri�-. . ( ��� ���-, � � , � %� t4,� / �l� / ' i�� � ��l'y'� t,��v'� L � � d:>a r� �1 ��r'��� � J �
� �; � J '� /^ ' -^..i��/,-� � f � 1 //���. �``�. '�r%' �, � ( r� 1 �{�t� i�i+,� � �;' -�. �.I��!��'i'�f�7 � �
y /f �� �1 � � � � t '�� G� 'Q j/�.� ,�1,� Ju i� 3% �� _�
� ' ,
-� x � � � _ , � , L I a � , ` � ,v � P + _ -
3 er5pal C.. ' '�ll � . t f � � `t�.��{"c � � /�;-�, i �`i 7 � �r t = \ . i . -. i � , ✓ . -
`? _ - f �_.- �.;-�� - \ _ �. � � � 1�� � � � zi � . ? � �. `` � .
p� , ( - _
;7 � i /r. (�� �� i q i � � J �� ,�/ ZF? / 1'` r`, � 1 n � I P� / � rr�ri _� �" '� l I
Z 1��. . , r �:, � � �� U-. � .`� �� � F'J'8 : /�, � -1A . ` � � l � � i � -�'�'--% \
_ �� � � /. ZC1/ �. %i � } f2�- � "l`. -� \ ''�-. $ y �.� ` ' �_,.� Z
p i", �� J I �'1 � i / --r��-t,� =F"� - _ 1� � f. i ,.� .._ (,- i �- .`+ �71� ..��..�`. �\ O
p —' - �� � i��� � �f i"� �i ��n ,i � � �7�13 / (�,� _n��.�-'�-- � ��.-1.��-.�� �� �.;1Cam.����. � �. `� �
0 9 � ' � . _ i � �'��` ' ` . R 1 � iiP ' � ✓ * O
�J� . � 4, � Id53, �✓ ' + ,_,�/ `\ /` �i. - �' i�� /j.`FZ L�i 6fi5 , _ _ N
M j _ , E �,''i � � , .�� 1 1 u-i
� �-' ... .. f/ .�2��-�f%�1}'i�ltl�'''� �Zl . � . - -- �'i �� . � \!l31 J ; ��� � /� m
. I � + � � . � �.' " t '�'�I�@ / ,I'"'"=_'�'"��hl L"' `�- " �...- � �;^, °i . , � - � - - 11-�- . '�- \�[ �F .
�. .. �i .�, .i-� . � � � i�• � �`�-: ..«r , " ���,�_� �1V.N \''��+.fy f .
� iJ'' � �� � ;l # � �, � �� � �.-_ � � � �� '� - - � ����� _�! ;�y- � �� ,���G � � �
'��f � f �%� r ' �,'
: _ �- ��2 35�3 , � t �t�a reeR� C r'� - �, � �i �p� ` ;' , � � i�� �t +i� f e�ek�� � %
� f;r� ..�� � . � ���� � r, •` � i
._ _ � f y
�� e . Csmp "�+ � r; r, ud �� z, ,
��j�w�) . i.- � _ ri �i . I� i " a /J t- � i + ._ . 17 1 ;w' YIY ' -'���. ..
���:��,�C ri! �z i'/ � y. : � N �' .. �I WL� �� �I /vvr �� �. 11
(,� .�. + f„ y . ., K -� , r� . 1• . � � .
�1 , t� I f \.,,, 1,���� �f ) � . f � . . ; _, `J -- -' .yO. �%�y':F..-
1 y j , > �,� �I � a �;. , r:-�, \ '� •;F o
'tnmi��,',�crol ,, -�i i��� r Y/--. -,'�"�1o('n�n Ch� rl �,' ' ��' „ "� ��
—, '°�, ; a ,� � .� �� , ��� �, ° �f' { . ,, " `� � \
,.
, � __ ���. ��,� , „ � � � � , ,�,� � ! , ,
� _ ` .-;
] f fi �
� l��d �-�� _ � � � � � � " ..���, ��' � . , i � � � � {�-y3�� � _
S �
, ,
� �i;
� `i�, .- -� --1 �'� f +� r � ��` �� ;;: oo � l.
� �. , j . ,,� � t /�` /,� �� �'—'` y � '� �_ � �u ',�� _ F
* ��+ t �, i f � � I ��.r` �� �/ 4 :6 � ;� � � , � - - ' - 4 ` -
� ' , � `, L y � " ,.,�f;� _ _
� 1 �; �. . ��-:y--�`- ,_'� \4�� ` ,- %` _ -� 3 'i % � - -- ' „- i
��'.. � r f� il `+ ,/ � E��J~ ��:' � r --� � -- >1_1�
f, r,
(� '� i
Z � � J � 1 / ---ct� ��1�/'��`.J , �i -$ `�L7JSEr,1@i1 � � � � / Z
o �
r�i / ^ /�i,� � � ' - _
. , - °
M -._, .�, �i'� � � • : .. "`-.._
�' ,. � . _ . - - . . '�~-��---�,� _ ..- � G YI M
f 3- o
, -.� �'�G?4�1��
('], . / �� �1: . � - - � � s �,r--._ c`"i
M � te* � � /� . � . � ,,. � ,_..�ti' .fy ',�- _ _ _ _ ,�f- =_- M
M - � � � � � I :i r` � � � r '3 '-f" , f �� . . .. \ M
N � y . -, l i r'. ! . 1 � • ,, , N
� -� �. � - �� /�� �/:�' - . � �G�� � �� ��i��e �� p � ~� � � . �'•�� M
[ ; -� �; � `� , .�j ' � - a �s��;', �' _ '`� ; Ga�i �� r' -, -- ��o�, 4 , e
�� �- ��-, I ���" i��� �'r � � �� " _� ' ` i. j � � � ���''� � ` �
�, rF�" / thre F'inn _ IG � �'' � � , � 1. � � ��Y-N�oJ�t . - ' , �
�-� � y �/� � �� � ,+e�. � Pin acle ��/ - �// i- � 1�� �.,� � �l ��� �'i� _ � � .I�" �� ����
.
.. �I l � . �'� " � - � � .. c ._�=-^!- - iJ ��'�. ' � : � � . � A �. � � •
" _ _ ` G. i ! \._ � ' �\� � � ��� � ��.�� � ;� 4 � `... .�I tP .._- /�_r �) , % . �y`�� � .�
� �� i ��,�'`1 ��6 ��7 �: � f r�su� �$ �
:
_ .,
- . .
� k''+� t��U �� � �� �� � _ � ��" "_ i , ' 1 � � 'j r : � � f �� � � - � �, _-
�'� i � � ��
` < < ./ � ! � � �'�'"'' ; l '�r' / }� tc -`
-, • ' �,;�; ��''� .��j,�J-C� � � , _Mo�r�^F�a�n �,RK`..
,
{V � q �.' 1
�� . � .� , ��,. �_ � � � � �� �
��� �: �� k 41P - � v � i �'� SCALE 124000
v
y -� : ,y. � ; �, �`ii ��� � "� � � � 5��;-�,r 0 1 MILES
�;J��,� , � � ; -_: ����- �.�� ���. � :
*` �. �� , 0 1000 YARDS
- f� ; /I�� � - , � � � �,_./� ' � � �� � I
r �
i � � � ,���� � �r" � , .� ' 0 1 KILOMETER
�� � � �
� , � � "t, � +�'. �� '�_�" ' ; l , ` -.. _ ,. � �
Name: STANDINGSTONE MT Location: 035.2453396° N 082.5355524° W NAD 27
Date: 4/24/2017 Gaption: SR 1127, Crab Creek Road
Scale: 1 inch equals 2000 feet Site 13 Culvert E�.
UT Mud Creek. Henderson
)

SR 1127 Crab Creek Road, Site 13 Culvert Extension
Natural Resources/Public Land Screening
� ` � . " � :�,��r � � � - � � �# > �
� � � "' ■ - � y� 1 -.. �,.fr. /l.r� ` ►`, ,� �, • i
' �}�.'� '� . �b, . [� � � : Y I �, ' �^ . � � � . ��'� .
�+I� - a "�_" 'i' t• � i . I . ' )t� � ;� ��• J;.
� � ,� , V1 H� ��P ': � {.
�' 4 i � �`�. � �
t'.
�I�'." . M`�' t . � t � �f �h�1, � F � � —
� . � f•• ��` + � � . ti� �. �' -f . .� r" � f /F': .- -
, - S': �� . 1 � ' —
f ' � � r A. �i1��• — �,. vbf ..� � f � �j � t r
�
i n � _ I , !}� �� 3, • � � .� 1 ��
t; R� � *+� �I,�! ,% � {ti-' . �,�' -
' ��, � �,; ✓� � .���i-r f9!( . J
_ �� `��� . . �fl .. . i � r �� . �" ' 'i .
� ' 7
� - � , - . .1' .. .
� � j-, � .,�. ��
� .� _ ��, .�� h �' * t�. �� '�R � j � " ` ,�� � �.�", '
t � �e ` . � �� ✓ -�, r ��� �i� 1 ' �� , � y.,' -�
Legend � : '� _ ` . ���} �
A ` �
� f "M ' �� �*1 _ • ,� '•� `l� � 1� f L '�'
. �`�' "' -� � �:� � � -
� hqworw ' ' �' n� !, .'.�' t• d�, �' �"�( �
ti y � _ � + �`�' !�'. 4 ; � , ���
cb100 arc -- �` �� +, � �_ .� �.- �. ' ,� ' �.; _ � �' �
— �� - ,; . �
� fedlands _ .� ~'�� 'y �� � ` �•' �' � ; t;� �` � `
-�' ,... � . � ,� s �
� Dedicated Nature Preserve r��.1�t. -; � Site 13 � i a, � �
Registered HeritageArea ` r � ',�r ' �`'"�-= a �. �� � __ T : �"" . : �� � ';
: :�' _' � .a '� '` � �
O r �
r �+� � �:; . . � • , _ . , . ,.
� Conservation Easement S' , +�1 `` _ �, , ' � �� � „ ,� ., � '� � .
� OtherProtection ._4 ���.. �f-'i'. •.�''• . !� �'�j'� ,� ��, r
� f •- . - ► ',� � ' ' r �„% +� - �
� Federal Ownership ,•� , 4� �J, - ,��jr � �
- � . - � .. ��• . .. ' ~Y �f Y 1
�State Ownership '�` _ �� - �;,. - - �" �, �
_ �� ��'� � . r . . „r ar �.N �� ��� y ' 1' ' ' I���.�' 1��'
�x> Local Government Ownership .r� � ' '� � t� � � � ti � _.`. �'•�� .�� � � � � � v �'�.
b�' � -` �,�* r I ��''� � `, � ,. a � ' �
� Private -a�, ". . "r, � �: �J'�,�;�r. � � ►" • y f n �: '� � ' � _ , �
A , 1� yJ:, j� , r,.,%�'jt'' � � 1�` I
Plant ,� -4 /r r .
Animal no listed species � � ' _ � e� � ' � �
•��k� .r > ` � . ,
� AnimalAssemblage � , -„�, 1 `�. t�, ` `� �,�", - ;.�� ��' -
J ,•. �� ,
r �� f� � f � �� ` � l , ' -.. y� •1 �� /f' � ,
� Natural Community ` . ` 4 �.u, , }, : �,- f;.�� .�F� r. � ��'� I ' j �_ �
i4 �;� -R'
�� NLEB_HUC12 a�.? . � a � , f
, • -"°�' � _ y �
� �''c> r/ r • ,r ! 'n ' j - � � �'�� �
�� ' ' '�,�, ' �, =1�+� ,
�, � ..r- � . j � • ,�y'
�� ! ,� 1 �� ' �'� Y .
� � ' . . .
� * 114 s - i. .�1�
�A ��: '��� � � � }, � . ,
� � �� �
,. �+� .,Y��� � ,NC' OneMar�, NC Cenfer for Ge
�
F _. � � �:__
0 50 100 200
Feet

E�i
U
O
�
h
U
�
O
U
SR P26 ViCvaTx WP
IOI 10 SCML
aana
ST.2�['E �F N�R�'II-i �r2R�LIIN � N.c ss-4<.
IDIVISI�N �F I'[IGII-IIWh��S
]-.91J
HE11lDERS0111 COLI11tTY
LOCAT701V: SR I127 CRAB CREEK ROAD FROM
TRAINSYVANIA COII�IITY LI1YE TO SR II23 LITTLE RIVER ROAD
TYPE OF WORK GUAI2I)RAIL IIeZSTALLAT'd01l� f� REMOVAL
���y'�q , �
SIIE _4II . . \Y,� Si�2 :66
I �4' V� \:� 5:
J ` 1 �� I
�� / 52fl�
' �-:�~����
CRpB CflEEK C41UF[li
/ " 1� _ �BWE SinR LN6EY^ /
� / � $il
. �pp
CpEEY• P
F
rRohcr ccvcrri
SS-49HCJ p34 mi/u)
511
HILL Fp
sn �r v*c u.v
4� �0 SC4C
dAROUEiiE �F
E STAS WAY
�WE STAq
,�,.,,,�.a�,>.
DIV7SION OF ffiGHWAYS
.o. .,. ,a, u.,...i.�.. xa..re.
WGM OF IVAY DAIL �t ��PS
I2TTA'GWiL e.w..-.M��
LPNE
51i
520
y.�
L v J+�••
p �@'(� y]F�
III P"'" .�r�y�rc�.
= t�M,
�-i9
_ - ' _=ca
--_S/TE 19L
NOTE:
STATION NUMBERS SHOWN ON
THIS MAP INDICATE THE APPROXIMATE
BEGINING STATION OF EACH SITE.
ROADNAY O£SI4V
fNWA'Yl'lt
���

Existing 24"
diameter
CMP
slightly
Crushed
'� '1. 1 ,'� : ^
µ
�7='-.�.Yi- .' .._- -
— _ _ — —�—�;,1sJ1��:
s �;_.:
L➢ � i � ��� - �
r l _
�;. �.
. . ? . �'.L � � �._ . .. . _ . _ ^ . I . . . , .. ^ U'�I�L�
�� �� � y� -
.Fr �� ' � � 1 ` ��.
� ��� . � � . �.
� �
�i. %� � � j 1 . 1 : '� - ' '
�. 1 �.. • - J� •. • • _ . �
, � .
. - r. . . ��' ,1]0 . � . y . ��
�: �- . . � .. . - ' ' . ^ . . ' ' . .
... ._ ... - . _. . .. _c .�r....) . . .. . ,
,'� ~'
� � �3i
�
�., . ,
J��
- y,�r —
-'S �/ -
�6 � �,.
i��;

��?00552 S��e 13 ph��o 3 Cra� CreePc �oo�Cir��
L. :�`'�l � ��'�,r ';�r. �- ��� ,�� 1 � P (/-�-�
. � A � ���44��� � �
. ' lh�f �' . i �d� - � ��C � �� 1���' .� � . .`�I��M�i�'..
�
4 � � .. - 1 I I
_ � , � � an. �� te` fa'' �},
ry h .
�� � � �, � � ` �.
fs � � -
., � , . all . -��° - �`t " .
\/ n � + � :
%: � � � �*
. � ,'� r �- ,.
� .�I Y � 1, r.'� �`' ''fE �I
' �Y 1 1 � ' r .4� �'-
_ ; = i
� ". 7 �', _.` i� �. f �
_ � � ��� ' ��� �� � �.�
� i ♦ � .
� 1., � 7 I.i1��'i/� � °re.�f Jr i
���Sj �� �'.�. � � �., .1.,� ��I�'.>���1 ���� .+..' .„tin
-r M�' 1 �, tc y� eIId!-� �i�.
� �' i 14jA .I A � _ . r.. ���
% i / .
� / ... �.. 1 '. la � ' � � 1 � �- �' ir -
' ^ �' - / T
d �`. � .y, ' �- I ii..
�: �\ � l� \.,: � �flbai / Y _
,��,
s , ., i ';, ✓���� � � � '
a— f 3 � �.
\\ ` Y .;' J I � ...�.c� ��.iG'�� � � y r I�.j
, , r , , - T �;: � �;; y � - "" r :A j�
_ , _- = � � .
' \ , �- ` - �-;
,� _ ;�' ;� �f`'}
5 _ , 1A , . �„ j
�'%
.�� _ _ _ -- 1 , � � "..v�= - '. i
`� � - ` : ' ' �r �� > li��l �
` . ,� y . , (,
� � i � �' h: .r _ ` ' I I Pi .7 � i-�'
t.,; �I �f�3 - .. i i .
I.�� ` � � ro � � yy,�t {��,�: `K�-ifvtr
,.,.. . ..' `� ' F �r. . '.\� � � 4 . .� i:..,.,� .Y�_��{2'
�': c. :
' � /�
�: �
— \ � N y
_ \ \\
.c��.�"__ � �_"�. .._ _ _ � .i
P��S�P�G�� �"6 ovT�T
. "�� i �j:,��7d � <a� � 'e � � � :: r �"j k:� �
.
tiv Jj��'� i d 7 '*�__ wk �aµ4 �
�� i•� � .i� . % p/�).
�_� _. �Jt�.. •

��0��52 ��"sc- � 3�hoto 5 Crab Creek loc��m� downstream
�lenderson County maintenance crews
have agreed to extend this pipe and
charge time to this projects
�V ��.
... � � � y�{1- �,��-;• „
' , �_ 1 ;i,u,, � r#.-�.K�� ��
' F ; 1 , - `'�; � � . p���
�l +i �p� � ...r �
��. � � �� ,."4��� . ... ; .;'
���I F�u�ry���yy'�� � �d�4 ,Y�yLn:'1.�,i�
1e �,�� '� 11� � 'AV ��'.pA �. ��i� o�ll� �' , �]
_ � A�t,� 1 �� t�'t � tI � �� R t-{r '
I ki i � � �11i � � �
Y ���;_�-. �W ! Itl�i i �r.'•� i � . -
��
.,. ,�
. �, � �.� � ,
� ; r I F,1 ' a
_
. � .� � �,.: ,� '
`r� ��* . . � -• '.
:'.i �� � '
�
� �.�� - -
4� -
_ J 4 ,
1
���d:��� r i-,.,
�;
� -
: yl r �' �
�� � �
� % i .._ . .. ..
- .S�'/°�
F ' �� '
� M � a
y ,«
;�
� "' - - ,
c' , -
i.
� � -. a "' y, . �
Extending Pipe -- � ^ ;: �. � �: �� �,. � -
� � feet downst�eam � - �, , ° ; , e �,'°��� _
X��
�
, �. � , ,
n .� • , '�x �w
� , a
rr,� � � � � ;l� , w��� .
,��r
' _
<
.'�' ti 'a ' ' �'ro.,1 t ` ��s _ 'r
. �����o� bu1� A� :.
/ .� , .
-p`�V . � v .�
t, ._ j
"':c i � .. ,:"v'
. NJ. . . . �� . �.__ . ' ... _. _... _ -.�, ., .. ...

MINIMUM CRITERIA DETERMINATION CHECKLIST
The following questions provide direction in determining when the Department is
required to prepare environmental documents for state-funded construction and
maintenance activities. Answer questions for Parts A through C by checking either "Yes"
or "No". Complete Part D of the checklist when Minimum Criteria Rule categories #8,
# 12(i), or # 15 are used.
TIP Project No.: SS-4914CJ
State Project No.: 44730.3.1
Structure No.: n/a
Project Location: Henderson - SR 1127 (Crab Creek Rd.) from Transylvania County to
SR 1123, near Flat Rock.
Project Description: SS-4914CJ - Henderson - SR 1127 (Crab Creek Rd.) from
Transylvania County to SR 1123, near Flat Rock. Total Length = 7.34 miles. Install
+/- 9,050' of guardrail along this 7.34 mile section of SR 1127 in 42 locations.
Anticipated Permit or Consultation Requirements: A 404 Permit may be needed for
two short culvert extensions needed to gain sufficient road shoulder.
Special Project Information:
The guardrail installations will occur within existing maintained r/w. Therefore, there
should be no effect of the work on wetlands or federally-listed species. There are no
Nationally-Listed or eligible historic properties in the vicinity of the guardrail work.
02/27/17 1 of 4

PART A: MINIMUM CRITERIA
Item 1 to be completed by the En_„g�neer.
l. Is the proposed project listed as a type and class of activity allowed under
the Minimum Criteria Rule in which environmental documentation is not
required?
If the answer to number 1 is "no", then the project does not qualify as a
minimum criteria project. A state environmental assessment is required.
If yes, under which category?
If either category #8, #12(i) or #15 is used complete Part D of this checklist.
' : . : U_ � ►/ u � . : : . ' _ _. � � _
YES NO
❑X ❑
Items 2— 4 to be completed by the E�ineer.
2. Could the proposed activity cause significant changes in land use � �
concentrations that would be expected to create adverse air quality
impacts?
3. Will the proposed activity have secondary impacts or cumulative impacts � �
that may result in a significant adverse impact to human health or the
environment?
4. Is the proposed activity of such an unusual nature or does the proposed
activity have such widespread implications, that an uncommon concern
for its environmental effects has been expressed to the Department?
� �
Item 5-8 to be completed by Division Environmental D acer:
5. Does the proposed activity have a significant adverse effect on wetlands; � �
surface waters such as rivers, streams, and estuaries; parklands; prime or
unique agricultural lands; or areas of recognized scenic, recreational,
archaeological, or historical value?
6. Will the proposed activity endanger the existence of a species on the
Department of Interior's threatened and endangered species list?
7. Could the proposed activity cause significant changes in land use
concentrations that would be expected to create adverse water quality or
ground water impacts?
02/27/17 2 of 4
❑ �
❑ �

YES NO
$. Is the proposed activity expected to have a significant adverse effect on � �
long-term recreational beneiits or shellfish, iinfish, wildlife, or their
natural habitats
If any questions 2 through 8 are answered "yes", the proposed project may not qualify as a
Minimum Criteria project. A state environmental assessment (EA) may be required. For
assistance, contact:
Manager, Project Development and Environmental Analysis Branch
P. O. Box 25201
Raleigh, NC 27611
(919) 733 —3141
Fax: [phone]
PART C: COMPLIANCE WITH STATE AND FEDERAL REGULATIONS
Items 9-12 to be completed by Division Environmental Officer YES NO
9. Is a federally protected threatened or endangered species, or its � �
habitat, likely to be impacted by the proposed action?
10. Does the action require the placement of temporary or permanent � �
fill in waters of the United States?
11
12
Does the project require the placement of a significant amount of
fill in high quality or relatively rare wetland ecosystems, such as
mountain bogs or pine savannahs?
Is the proposed action located in an Area of Environmental
Concern, as defined in the coastal Area Management Act?
Items 13 — I S to be completed by the Engineer.
13. Does the project require stream relocation or channel changes?
Cultural Resources
14. Will the project have an "effect" on a property or site listed on the
National Register of Historic Places?
15. Will the proposed action require acquisition of additional right of
way from publicly owned parkland or recreational areas?
❑ �
❑ �
❑ �
❑ �
� �
Questions in Part "C" are designed to assist the Engineer and the Division Environmental
Officer in determining whether a permit or consultation with a state or federal resource
agency may be required. If any questions in Part "C" are answered "yes", follow the
appropriate permitting procedures prior to beginning project construction.
02/27/17 3 of 4

PART D: (To be comqleted when either categorv #8, #12(i), or #15 of the rules are
used.
Items 16- 22 to be completed by Division Environmental Officer.
16. Project length:
17
:
Right of Way width:
Project completion date:
19. Total acres of newly disturbed
ground surface:
20. Total acres of wetland impacts:
21
22
Totallinear feet of stream impacts:
Project purpose:
If Part D of the checklist is completed, send a copy of the entire checklist document to:
Don G. Lee
State Roadside Environmental Engineer
Mail Service Center 1557
Raleigh, NC 27699-1557
[phone]
Fax [phone]
Email: [e-mail]
DocuSigned by:
Reviewed by:
s�w� c��,
Steve Cannon, PE
Division 14 District 1 Engineer
DocuSigned b�:
1���.,l?�`,�-
Dave c enry
Division 14 Environmental Officer
02/27/17 4 of 4
Date: z/2�/zov
Date:
z/z�/zov