20170806 Ver 1_SR 1158, Application_20170628

STATE OF NORTH CAROLINA
DEPAR'TMENT OF TRA�TSPORTATION
R()Y COOPER
Gorlgxt�oR
JU.l7� 2.�, �.�i 17
Mr. Eric Alsmeyer
U_ S. Army Corps of Engineers
Raleigh Regulatory Field Office
3331 Hezitage Trade Drive, Suite 105
Wake Farest,lVC 27587
J�MES H- T120GD�N, TII
SECRETAR'Y
Subject_ Nationwide Pernut #�4
SR 1158, Conley Shumaker Raad
Wilkes Couniy, North Carolina
Project Number: 11C.0�7165 (DWR Permit Fee: �570)
Dear Mr. Alsmeyer:
The NG DepaTtment of Transpartatic�n is scheduled to grade, drain, base and pave SR
1158, Conley Shumaker Road in Wilkes County. Total project length is 1.38 miles.
Irnpervzous surface area will increase by about 0.33 acres. This project will require the
replacement af three wet pi�es as shown belaw.
5tream l
Station
16+57 24"x 32' 3b"x 50'
2b+80 36"x 41' 42"x 50'
43+55` 36"x 3$' 42"x 45'
Permanent Streambed Fill = 34'
Temt�ararv Dewaterin� =12Q'
Riprap - To��1
C�n :�cts
Dewatering � ���
10 40 68
1{? 40 �9
10 40 57
Bank Stabilization = 30'
Total Pro.ject Ymqacts = 1$4'
I This pipe is currently perched wzth a pluxige pool at the autlet. We will unperch the
pipe by submerging the Qutlet 0_5' below the plunge paol water surface elevatian.
All three strearn crossings cazzy different UTs to Stony Fc�rk (elass: C) in the Yadkin
River Basin. The replacement of these structures will require temporary dewatering. An
impervious sandbag dik� will be constructed upstrearn of the existing strtictures to create
a sma11 pavl. Cleaza water v,Fill temporarily be p�nped arpund the construction areas and
will be discharged downstream. Any dirry water located inside of the canstructaon areas
MatltngAddress: Telaphone: (336}667-9111 Lacation:
NC DEPARTMENT OF TAA%TSPORTATiON Fax: [phone] AADRESS 2
DTViSION 11 Customer Servace: 1-877-368-4968 CITY, NC ZIP
8�1 STATESVILL6 RdAI3
NORTH WILKESBORO, NC 28b59 Websire: www.ncdvt.gav

Mr. Eric Alsmeyer
SR 1158, Goneiy Shumaker Road
June 28, 2017
wiil be pumped into a silt bag if necessary. Once the new pipes are in p�ace, the
impervious dikes will be removed and preconstruction streambed elevation� will be
restored.
This praject was reviewed for the presence of threatened and endangered species in the
field and I have also included a quezy of the NCNHP database. Based on ihe project area
mapped with my request, the database search indicates that there are no recorc�s fox rare
species, impartant natural communities, natural areas, or conservation/managed areas
within the proposed project boundary (see attached}. Tliere will be approxi�mately 0.75
acres of tree cutting at the project location due to cut and fill work. The NLEB is listed as
a protected species in thi.s county but the project does not fall within Q.25 rniles o� any red
HUC identifed i�n the SLQPES spelled out in the Natianwide Permit Regional
Conditions. We do nat antic'rpate any impact to any oiher federaIly listed species. This
praject is �ocated within a trout watershed.
Cultural resource co�npliance wvrk has been completed. 1`�o archaealogical resoi�rces or
histo�ie properties will be affected by this project (see attached).
The project impacts are not significant in nature and should not remove ar degrade
existing water quality uses. 5torzxiwater will be routed through grass or rock lined
ditches, depending on the diteh Iine slope. Dissipater pads r�vill be installed at pipe outlets
as appro�riate. Pipe sizes used will be the minimum necessaxy to cre�te a safe roadway.
Sy uiilizing the erosion control measures outlined in the attachments to this application,
downstream water quality standards will be protected. Overall water quality in the area
will be unproved by paving the ABC travel lanes. Ali appropriate BMPs will be used
durin.g construction_
Attached is a Preconstruction Natification Farm, plan sheets with proposed erosion
control nneasures, a marked county map and a marked tapograpb.y map.
By copy of this eleetronic letter, it is rec�uested that the Division of Water Resources,
401/Wetlands Unit, issue the appropriate permit for canstruction of this praject. It is
requested that any commen#s related to the 401 certifieation be electronically forwarded
directly to me vvith a copy sent to the US Army Cflrps of Engineers.
V4'e wauld like to begin construction as soon as passible. If further information is
required, please let me knflvv. Yaur early review and consideration will be appreciated.

Mr. Eric Alsmeyer
SR 1158, Conety Shumaker Raad
.1une 28, 2Q 17
Sincerely;
Heath Slaughter
Dxvision Environrnental Officer
Enclo�ures
cc: Amy Cha�man, Divisian of Watex Resource5
Dawe V4'anucha, Divisian of Water Resources
Ma�la Cha.mbers, Wildlife Resources C�manission
Brian Ha�nby, County Maintena.�ce Engineer
Zack Sauther, Roadside Environmer�tal Ficld C3perations Technieian

�C3F�ArFRQ Office Use �nky:
� r Corps action ID no.
� i` � Y DWQ project no.
����� Form Version 1.3 Dec 10 2008
Pre-�onstructivn Notificatian PC Form
A, Applicant Information
1. Processing
1 a. Type(s) o# approval sought from the ���ction 404 Permit ❑ Section 10 Permit
Corps:
1b. Specifiy Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1c. Has tt�e NVNR or GP number been verified by the Corps?
❑ Yes � Np
1 d. Type(s) of appror+al sought from the DWQ (checic all that a�ply}:
� 407 Water Quafity Ce�tification — Regular ❑ Non-40�4 Jurisdictional General Permit
❑ 4Q1 Water Quality Cerkif�cation — Express ❑ Riparian Buffer Authanzation
1 e. Is this notificat�on solely for the record For the reeard only for DWQ 4a1 Far the record anfy for Corps Permit.
because written approval is not required? Certification:
❑ Yes � No ❑ Yes � �Q
1f_ Is payment into a mitigation bank or in-lieu fee p�ogram propvsed for mitigation � YeS ❑ No
of impacts? If sa, attach the aceeptance ietter from mitigation bank or in-fieu
fee program. _
1g. Is the project located in any of NC's twenty coastal caunties. If yes, answer 1 h ❑ Yes
belaw.
1 h. Is the project loca#ed within a NC DCM Area af En�ironmenta! Cancem (AEC}? ❑ Yes
2. Project Information
2a. Name of project:
2b. County:
2c. Nearest municipality 1 town:
2d. Subdivisivn name:
2e. NCDQT only, T.i.P. or state
project no.
3. Owner Information
3a. Name{s) on Recorded Deed_
3b. Deed Book and Page No.
3c. Responsible Party (far LLC if
applicaf�le}:
3d. Street address:
3e. Ci#y, state, zip:
3f. Tefephone no.:
3g. Fax no.:
3h, Email adciress:
SR 1158, Conley Shumaker Raad
Wilkes
Wilkesboro
1 'i C.095165
NCDOT
801 Statesville Road
Narth Wilkesboro, NC 28659
336-90�-9202
336-667-4549
[e-mail]�
►� •
1� .
Page 1 of 10
PGN Form — Version 1.3 December 10, 2008 Version

Page 2 of � 0
I'CN Form — Version 1.3 December 1�D, 20Q8 Version

�. Project Information and Prior Project History
1. Properly Identification
1a. Property identificaiion no. (tax PIN or parcel ID):
1 b. Site coordinates (in decimal degrees): Latitude: 36.11231 Longitude: - 81.35140
(DD.dDDDi)D) 4-oo.00aoao}
1 c. Property size: 8.3 acres
2. Surtac� Waters
2a. Name of nearest body af water (stream, ri�er, etc_) to UTs to Stony Fork
proposed project:
2b. Water Quality Classification of nearest receiving water: C
2c. Ri�er basin: Yadkin
3. Pr�ject Descriptian
3a. Describe the existing conditians an the site and the genera! land use in the vicinity of the project at the time of this
application:
Unpaved secandary road in a rura! area._
3b. List the total estimated acreage of ali existing wetlands on the property:
0 acres
3c. List the total estimatecl linear feet of afl existing streams {intermittent and perennial} on ihe proper[y_
200 linear feet
3d. Explain the purpose of the proposed project:
Secondary Road Improvement
3e. Describe the overall project in detaii, including the type of equipment to be used:
See attached cover lefter.
4. Jurisdictional Determinations
4a. Ha�e jurisdictional wetland or stream determinations by the
Corps or State been requested or obtain�d for this property 1 � Yes � No ❑ Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictianal determination, wFiat type � preliminary ❑ Fina!
of determination was made?
4c. lf yes, who delineated the jurisdictional areas? Agency/Cansultant Company:
Name {if known}: Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project Histary
5a. Have permits ar certifications been requested or obtained for 0 Yes � No ❑ lJnknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructians.
6. Future Project Plans
6a. ls this a phased praject? ❑ Yes � Na
6b. If yes, explain.
Page 3 of 10
�CN Form — Version 1.3 December 1fl, 2008 Version

C. Proposed impacks In�en#ory
1. Impacts Summary
1 a. Which �ections were compfeted beEow for yaur praject (check all that apply}:
❑ Wetlands � Streams - tributaries ❑ BufFers
❑ Qpen Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then camplete this question for each wetland area impaeted.
2a. 2b, 2c. 2d. 2e. 2f.
Vlletland impact Type of jurisdiction
number — Type of impact Type of wetland Forested {Corps - 404, 10 Area o# impact
Permanent (P) or {if fcnt�wn) DWQ — non-4D4, other) (acres)
Tem ora
W'1 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W2 ❑ P 0 T ❑ Yes ❑ Corps
❑ Np ❑ DWQ
W3 ❑ P❑ T _ ❑ Yes ❑ Corps
❑ No ❑ DWQ
W4 ❑ P � T ❑ Yes ❑ Carps
❑ No ❑ DWQ
W5 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W6 ❑ P❑ T 0'Yes ❑ Gorps
❑ No ❑ DWQ
2g. Total wetland impacts
2h. Comments:
3. 5tream Impacts
If there are perennial or in#ermittent stream impacts (including temporary 9mpacts) proposed on the site, then complete this
question for afl stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream narr�e Perenniai Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
f'ermanen# (P) or intermitEent DWQ — non-404, width (linear
Temporary (� (��Ti? other) (feei) feet)
S1 � P� T �'iping, Riprap and UT #1 to Stony � PER � Corps 2 �$
dewatering Fork ❑ INi � DWQ
S2 � P� T Piping, Riprap and UT #2 to Stony � PER � Corps 2 �g
dewatering Fork ❑ INT �( DWQ
S3 � P� T PiPing, Riprap and UT #3 ta Stony � PER � Corps 3 57
dewatering Fork ❑ WT � DVIlQ
S4 ❑ P � T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S5 ❑ P❑ T ❑ PER ❑ Gorps
❑ INT ❑ DWQ
S� � � ❑ � ❑ PER ❑ �arps
❑ iNT ❑ DWQ
3h. Total stream and trihutary iinpacts � 8'�
3i. Camments: 34' piping, 34' nprap, 120 iemporary dewatering
Page 4 of 10
PCN Farm — Version 1.3 D�cember 10, 2d08 Version

4. Open Water Impacts
If there are prap�sed impacts ta lakes, ponds, estuaries, tributaries, sounds, ihe Atlantic Ocean, or any ather open water of
the U.S. then indi�idually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number — {if applicable) Type of impact Wateri�ody type Area of impact (aer�s)
Permanent (P) or
Tem ora
Q1 ❑P❑T
02 ❑P❑T
03 ❑P[]T
04 ❑P�T
4f. Tot�l open water impacts
4g. Comments:
5. Pond or Lake Construction
If ond or lake construction ra osed, ihen com lete the chart below.
5a. 5b. 5c_ 5d. 5e.
Wetland Impacts {acres) Stream Impacts (feet) Upfand
Pond ID Proposed use flr purpase (acres}
number of pond
Flooded Filled Excavated Flooded Fifled Exca�ated Flonded
P1
P2
Sf. Total
5g. Comments: NIA
5h. Is a dam high hazard permit required?
❑ Yes � Na If yes, permit ID no:
5i. Expected pond surFace area (acres}:
5j. Size o# pond watershed (acres):
5k. Metf�od of construction:
6. Buffier Impacts (far DWQ)
If project will impact a protected riparian buffer, then camplete the chart belovu. If yes, then indi�idually iist aA buffer impacts
below. If an impacts require miti aiion, then ou MUST fill out Section D af this form.
6a,
❑ Neuse ❑ Tar-Pamlico ❑ Other.
Praject is in which protec#ed basin? ❑ Catawba ❑ Randleman
6b. 6c. 6d_ 6e_ 6f. 6g.
BufFer impact
number — Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream narne mi#igation (square feet) (square feet)
Tem ora im act re uired?
B1 ❑POT ❑Yes
❑ No
B2 ❑P❑T ❑Yes
❑ No
B3 ❑P❑T ❑Yes
❑ hJo
bh. Total bnffer impacts
6i. Comments:
Page 5 of 10
PCN Farm — Version 1.3 ❑ecember 10, 2Q08 Version

D_ Impact Justiflcation and Mitigation
1. A�oidance and Minimization
1a. Specificalfy describe measures taken ta a�oid ar tninimize the praposed impacis in designing project.
Proposed pipe lengths are #he shortest needed to adequately con5truc# the roactway_
1 b. Specifically describe rneasures taken to avoid ar minimize the proposed impacts through construction techniques.
All appropriate BMPs wil! be used during construction
2. Compensa#ory Mitigation for Impacts to Waters of the U.S, ar Waters of the State
2a. Does the project require Compensatory Mitigation for � Yes ❑ No
impacts to Waters af the 11.S. ar Waters af the State?
2b. Ifyes, mitigation is rec�uired by (check all that apply): ❑ DWQ � Corps
❑ Mitigation bank
2c. If yes, which mitigation aption will be used for #his
project? � Payment to in-lieu fee program
❑ Permit�ee Responsible Mitig�tian
3. Corrtplete if Using a Mitigation Bank
3a, Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Camplets ifi Making a Payment to In-lieu Fee Progratn
4a. Approval le�ter from in-lieu fee pragram is attached. � Yes
4b. Stream mitigation requested: 68 linear feet
4c. {f using stream mitigation, stream iemparature: ❑ warm � cool ❑cald
4d_ Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigatian requested: acres
4f. Non-riparian wetland mitigatian r�equested: acres
4g. Coastal (tidal) wetland mitigatian requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsihle mitigation plan, provide s description of i'he proposed mitigation plan.
Page 6 af 10
PCN Form — Version 1.3 Qecember '10, 2008 Version

6. Buffer Mitigatian (S#ate Regula#ed Riparian Buffer Rules) — requ�red tay DWQ
6a. Will the project result in an impact within a prot�cted ripar�an buffer that requires ❑ Yes ,� No
buifer miiigation?
6b. If yes, then identify the square feet of irnpact ta eac� zane of #he riparian bufi�er that requires mitigation. Calculate the
amount af mitigation required.
�c. 6d. 6e.
Zone Reason for impaet Total impact Multiplier Required mitigation
(squaee feet) (square feet)
Zone 1 3� (2 far Catawba)
�ane 2 1.5
6f. Total bufFer mitigartion required:
6g. If buffer mitigation is required, discuss what type of mitigation is peoposed (e.g., payment to private tnitigation bank,
permi#tee respor�sible riparian buffer restoration, payment in#o an appro�ed in-lieu fee fund).
6f�_ Cc�mments:
Pag�e 7 of 1 Q
PCN Farrr� — Versian 1.3 December � 0, 2008 Version

E. Stormwater Management and Diffuse Flornr Plan (required by DWQ)
1. Diffuse Flow Plan
1a_ Does the project include or is it adjacent to protected riparian buffers identified � Yes � No
within ane of the NC Riparian Buf�er Protec#ion Ftules?
1 b. if yes, then is a diffuse flaw plan included? 4f no, explain why.
❑ Yes ❑ No
Comments:
2. Stormwater Mana ement PEan
2a. What is tt�e overall percent imperviousness af this project? 40 %
2b. Does this project require a Starmwat�r Management Plan? � Yes ❑ No
2c_ If this project DOES NOT require a Stormwater IVlanagement Plan, explain why:
2d. It this project DOES require a Stormwater Managerrzent Plan, then pravide a brief, narrati�e description of the plan:
5ee cover letter.
❑ Certified Local Ga�emment
2e. Who will be responsible for the re�iew of the Stormwater Management Plan? ❑ DWQ Stormwater Program
� DWQ 4Q7 Unit
3. Certified Local Government Stormwater Re�iew
3a. In which iocal govemment's jurisdiction is th�s project?
❑ Phase Il
3b. Which af the following locally-implemented starmwater management programs p���
apply (check all #hat apply): ❑ USMP
❑ Water Supply Watershed
❑ Other:
3e. Fias the approved Stormwater Management Plan with proof of approwal been ❑ Yes ❑ No
attached?
4. �WQ Stormwater Pro ram Reaiew
❑ Coastal eounties
❑ HQW
4a. Which of the followirtg state-implemented siormwa#er managernent programs apply � p�{W
(check all that apply): ❑ Session Law 2006-246
❑ Other:
4b. Has the appro�ed Stormwater Management Plan wEth proof of approval been
attached? ❑ Yes ❑ No
5. DWQ 401 Unit Stormwater Review
5a. Does the Starmwater Management Plan meek the appropriake requirements? ❑ Yes ❑ No
5b. Ha�e all of th� 4Q1 Unit submittal requirements been met? [� Yes ❑ No
Page 8 of 10
PCN Form — Version 1.3 December 10, 2008 Version

F. 5upplementary Information
1. Enr�ironmental Docurnentation {DWQ Requirement)
1 a. Does the praject in�olve an expentiiture of public (federallstate/local) ft�nds or the � Yes ❑ No
use af public (federallstate} land?
1 b. If you answered "yes" to the abo+re, does the project require preparation of an
environmental documen# pursuant to the requiremenis of the Natianal or State ❑ Yes � No
(North Carolina) Environmental Policy Act (NEPAlSEPA}?
1 c. If you answered "yes" to the above, has the document re�iew been fin�alized by the
State Clearing House? (If so, atiach a copy of tfie NEPA or SEPA final appraval
I�tter_) ❑ Yes ❑ No
Comments:
2. Violatians (DWQ Requirement}
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), lsolated
Wetland Rules (15A NCAC 2H .134D), DWQ Surface Water or We�land Standards, ❑ Yes � No
or Riparian Buffer Rules (15A �iCAC 2B .0200)?
2b. Is this an afier-the-fact permit app�ication? ❑ Yes �I No
2c. I€ you answered "yes" to one or bot� of the above guestions, provide an explanation of the �iolation(s}:
3. Cumulati�e Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonabfy anticipated future impacts) resuft in � Yes � No
additianal de�elopment, which could impact nearby downstream water quality?
3b. If you ar�swered "yes" to the abave, submit a qualitative or quantitative cumulative impact analysis in ac�ordance with the
most recent DWQ policy. If yau answered "no," provicie a short narrati�e descrip#ion.
4. 5ewage Disposal (�WQ Requirement}
4a. Gleariy deiail the ultimate treatment methtids and dispositian (non-discharge or discharge) of wastewater generated from
the praposed project, or available capacity of the subject facility.
NIA
Page 9 of 10
PGN Farm — Version 'I .3 Decerr�ber 14, 2068 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will fihis project occur in or near an area with federaliy pro#ected species or � Yes � IVo
habitat?
5b. Have you checked with the USFWS conceming Endangered Species Act �] Yes � No �
impacts?
❑ Raleigh
5c. lf yes, indica#e the USFWS Field 4f�ce you have contacted.
❑ Ashe�ilie
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designate�d Critical
hlabitat?
NFiP, GIS and visuai observation.
6. Essential Fish Habitat (Corps Requirement}
6a. Wi{! this project occur ir� or near an area designated as essentia! fish hat�itat? ❑ Yes � No
6b. What data saurces did yau use to determine whether your site would impact Essential Fist� Habitat?
NOAA
7. Historic or Prehistoric Culturat Resources [Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
go�ernments have designated as ha�ing histor�c or cuiturai preservation � Yes � No
status (e_g., Nafional Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources ciid you use to determine wh�ther your site would impact histaric ar archeological resources?
Project was re�iewed by the NCDOT HEU.
8. Flood Zone Designation {Carps Requirement)
8a. Will this proj�ct occur in a�EMA-designatecf 100-year floodplain? ❑ Yes � No
8b. If yes, explain how project mee#s FEMA requirements:
8c. Wha# source(s) did you use tv make the floodplain determination? ncfloodmaps
J. Hea.th Slaughter 6/28/17
Applicant/Agent's Prinfied Name pplicanUAgenYs S� � ature Date
(AgenYs si nature is valid only if an aufho akion letter from the applicant
is rovid
Page 10 af 10
PCN Form — Version 1.3 December 10, 2008 Version