20081650 Ver 1_Application_20081103

GAYZ,
STATE of NORTH CAROLINA
o?
/Vol/
?ry
DEPARTMENT OF TRANSPORTATION
MICHAEL F EASLEY LYNDO TIPPETT
GovFRNOR SFCRFTARI
October 28, 2008
Mr Steve Lund ® 8
USACE, Ashville Field Office
151 Patton Avenue, Room 208
Asheville, NC 28801-5006
SUBJECT Bridge #219 Replacement on SR 1350 (Rehobeth Church Road), Cleveland
County
Dear Mr Lund
The North Carolina Department of Transportation proposes to replace a deteriorating bridge on
SR 1350 (Rehobeth Church Road) in Cleveland County The existing two span, timber deck
bridge, will be replaced with a 100-foot(L) by 30-foot(W) single span concrete slab deck bridge
and two 25-foot long approach slabs at each end to align with the existing road Approximately
200 tons Class II nprap will be utilized around the bridge end bents for structure stabilization
It may be necessary to construct a temporary causeway (- 45 feet by 25 feet) to facilitate the
removal of the existing in stream bridge pier Removal of existing bridge will be performed so
as not to allow debris to fall into the channel
Upon project completion, the channel disturbed by the temporary causeway will be restored to
pre-project conditions and the surrounding area seeded and stabilized The total scope of the
work will result in 100 feet of permanent nprap impacts to Brushy Creek, which is classified as
Class C waters by the Division of Water Quality
The project area is not located within '/z mile of any critical watershed areas nor is SR 1350 a
rural or urban arterial, therefore, hazardous spill basins are not required Enclosed is the
hazardous spill basin checklist This office has conducted a GIS and field survey for the project
for histoncal sites and threatened/endangered species sites No sites listed on the National
register of Historic Places are located in the vicinity of the project nor did there appear to be any
eligible structures The federally listed species for Cleveland County (USFWS listed dated
January 31, 2008) include the Dwarf-flowered heartleaf (He uslihi 11(11111/o1u) National Heritage
Post Office Box 47 Shelby, North Carolina 28 1 5 1-0047
art 7 ?? R i?{ ?
Page.2i
Sk 1350, Rehobeth Church Road, BR# 219
(O,ctober 28; 2008
Program records document the nearest Dwarf-flowered heartleaf location approximately 0 51
miles north of the proposed project area The heartleaf is usually found on dry to moist ravine
slopes' (usually north facing and of the oak-hickory-pine forest type) and in boggy areas near
springheads There is no suitable habitat within the proposed project area and no species were
observed NCDOT is recommending a finding of "no effect" for T&E species and historic sites
I have enclosed a pre-construction notification for a GP-198200031, sketches of planned
activities and location maps relative to the project
Project information for the 401 Automated Payment Procedure is as follows
• Work order number 150464-55120005-33718-3372
• TIP# B-4469
• Project Category $240 00 Fee
If you have any questions or concerns please feel free to contact me at [phone] Thank
you for your time and consideration on this matter
Respectfully yours,
M L Holder, P E
Division Engineer
Twelfth Division
BY JA,44 i-
Trish Simon
Division 12 Environmental Supervisor
Enclosures
cc Brian Wrenn, Division of Water Quality (Transportation Permitting Unit)
Polly Lespinasse, Division of Water Quality (Mooresville Regional Office)
Office Use Only: Form Vu .ion Mwdi 05
USACE Action ID No. DWQ No. 2 0 0 8 1 6 5 0
(11 any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" )
1. Processing
Check all of the approval(s) requested for this project
® Section 404 Permit ? Riparian or Watershed Buffer Rules
H Section 10 Permit (_J Isolated Wetland Permit from DWQ
® 401 Water Quality Certification ? Express 401 Water Quality Certification
2 Nationwide, Regional or General Permit Number(s) Requested GP-198200031
(WQC#3704)
3 If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here ?
4 If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here ?
5 If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here ?
H. Applicant Information
1 Owner/Applicant Information
Name Mike Holder N C Department of Transportation
Mailing Address P O Box 47
Shelby NC 28151
Telephone Number 704-480-9020 Fax Number 704-480-5401 _
E-mail Address
2 Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant )
Name Trish Simon
Company Affiliation N C Department of Transportation
Mailing Address P O Box 47
Shelby NC 28151
Telephone Number 704-480-9044 Fax Number 704-480-5401
E-mail Address _ tsimon@dot state nc us
Page I of 8
Ill. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties Both the vicinity map
and site plan must include a scale and north arrow The specific footprints of all buildings,
impervious surfaces, or other facilities must be included If possible, the maps and plans should
include the appropnate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than l 1 by 17-inch format,
however, DWQ may accept paperwork of any size DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided
1 Name of project SR 1350. Rehobeth Church Rd, Cleveland County Bridge #219
Replacement
2 T 1 P Project Number or State Project Number (NCDOT Only) B-4469
3 Property Identification Number (Tax PIN) N/A
4 Location
County Cleveland Nearest Town Shelby
Subdivision name (include phase/lot number) N/A
Directions to site (include road numbers/names, landmarks, etc ) From Shelby take Hwy
226 north towards Polkville turn left at Rehobeth Ch Rd site approx 1 5miles
5 Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody )
Decimal Degrees (6 digits minimum) 352228 25 ON 0813811 11 °W
6 Property size (acres) 1 15 acres
Name of nearest receiving body of water Brushy Creek - Class C waters (from source to
First Broad River)
8 River Basin Broad
(Note - this must be one of North Carolina's seventeen designated mayor river basins The
Ri\er Basin map is Mailable at _ ) -'u UlTe nr ,ic /0111111 n»rIc )
9 Describe the existing conditions on the site and general land use in the N icinity of the project
at the time of this application Sui rounding area is forested Bridge on pa\ ed secondary
road
Page 2 of 8
10 Describe the overall project in detail, including the type of equipment to be used Replace
existing detenoratine two span timber deck bridge with concrete slab deck bridQe The
project will be constructed utilizing typical heavy equipment trackhoe backhoe etc_
11 Explain the purpose of the proposed work The purpose of the proposed work is to replace
a deteriorating bridge for the safety of the travelling public
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn Provide photocopies of previously issued permits,
certifications or other useful information Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable) If this is a NCDOT project,
list and describe permits issued for prior segments of the same T I P project, along with
construction schedules
N/A
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application
No future permit requests are anticipated for this project
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project Each impact must be
listed separately in the tables below (e g , culvert installation should be listed separately from
riprap dissipater pads) Be sure to indicate if an impact is temporary All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems
Wetland and stream evaluation and delineation forms should be included as appropriate
Photographs may be included at the applicant's discretion If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section VIII below If additional
space is needed for listing or description, please attach a separate sheet
1 Provide a written description of the proposed impacts Minor impacts from riprap
stabilization under bridge along banks of channel
2 Individually list wetland impacts Types of impacts include, but are not limited tc
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc For dams,
separately list impacts due to both structure and flooding
Page 3 of 8
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e g, forested, marsh,
herbaceous, bog, etc
) Located within
100-year
Flood lain
loos no) Distance to
Nearest
Stream
(linear feet) Area of
Impact
(acres)

Total Wetland Impact (acres)
3 List the total acreage (estimated) of all existing wetlands on the property
0
4 Individually list all intermittent and perennial stream impacts Be sure to identify temporary
impacts Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e g , cement walls, rip-rap, crib
walls, gabions, etc ), excavation, ditching/straightening, etc If stream relocation is proposed,
plans and profiles showing the linear footpnnt for both the original and relocated streams
must be included To calculate acreage. multiply length X width then divide by 41 Sin
Stream Impact Perennial A%erage Impact Area of
Number Stream Name Type of Impact or Stream Width Length Impact
(indicate on map) Intermittent Before Impact (linear feet) (acres)
1 Brushy Creek Bridge bent stabilization Perennial 60 100 0 14
1 Temp causeway for bent ..

remoN al 60 45ft x 25ft 0 03
Permanent Stream Impacts (by length and acreage) 100 0 14
TempomamYStream impacts (by length and acreage) 45ft r 25ft 0 03
Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U S ) Open water impacts include, but are not limited to
fill, excavation, dred-ams?, flooding- drainage- bulkheads etc
Open Water Impact
Site Number
Name of Waterbody Type of Waterbody Area of
(if applicable) Type of Impact (lake pond estuary, sound, bay Impact
(indicate on ma) ocean etc) (acres)

Total Open Water Impact (acres)
6 List the cumulative impact to all Waters of the U S resulting from the ro ect
Stream Impact (acres) Permanent 0 14
Wetland Impact (acres) 0
Open Water Impact (acres) 0
Total Impact to Waters of the U S (acres) 0
Total Stream Impact (linear feet) Permanent 100
Page 4 of 8
7 Isolated Waters
Do any isolated waters exist on the property? ? Yes ® No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet) Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE
8 Pond Creation NO POND IMPACTS
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections Also, the proposed pond should
be described here and illustrated on any maps included with this application
Pond to be created in (check all that apply) ? uplands ? stream ? wetlands
Describe the method of construction (e g, dam/embankment, excavation, installation of
draw-down valve or spillway, etc )
Proposed use or purpose of pond (e g , livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc )
Current land use in the vicinity of the pond
Size of watershed draining to pond Expected pond surface area
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible Also discuss how impacts
were minimized once the desired site plan was developed If applicable, discuss construction
techniques to be followed during construction to reduce impacts The existing bridge must be
replaced for the safety of the travelling public
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H 0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to peremiial
streams
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed Examples of mitigation that may be appropriate and practicable include,
but are not limited to reducing the size of the project, establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams, and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed
Page 5 of 8
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
htt) /,h2o enr etate nc us%ncwetlands strm<_Tide html
Provide a brief description of the proposed mitigation plan The description should provide
as much information as possible, including, but not limited to site location (attach directions
and/or map, if offfsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e g , deed restrictions, conservation easement, etc ), and a
description of the current site conditions and proposed method of construction Please attach
a separate sheet if more space is needed
Mitigation not anticipated
2 Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP) Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form For
additional information regarding the application process for the NCEEP, check the NCEEP
website at Imp h2o enr state nc us,wrp,index htm If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information
Amount of stream mitigation requested (linear feet)
Amount of buffer mitigation requested (square feet)
Amount of Riparian wetland mitigation requested (acres)
Amount of Non-riparian wetland mitigation requested (acres)
Amount of Coastal wetland mitigation requested (acres)
IX. Environmental Documentation (required by DWQ)
I Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ® No ?
2 If yes, does the project require preparation of an em ironmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation
Yes ? No
3 If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter Yes ? No ?
Page 6 of 8
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project The applicant must also provide
justification for these impacts in Section VII above All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan All buffers must be shown on a
map, whether or not impacts are proposed to the buffers Correspondence from the DWQ
Regional Office may be included as appropriate Photographs may also be included at the
applicant's discretion
I Will the project impact protected riparian buffers identified within I5A NCAC 2B 0233
(Meuse), 15A NCAC 2B 0259 (Tar-Pamlico), 15A NCAC 02B 0243 (Catawba) 15A NCAC
2B 0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes ? No
2 If "yes", identify the square feet and acreage of impact to each zone of the riparian buffers
if buffer mitigation is required calculate the required amount of mitigation by applying the
buffer multipliers
Zone* Impact Multiplier Required
(square feet) Mitigation
i 3 (2 for Catamba)
2 15
Total
` Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel, Zone 2 extends an
additional 20 feet from the edge of Zone 1
If buffer mitigation is required, please discuss what type of mitigation is proposed (i e ,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund) Please attach all appropriate information as identified
within 15A NCAC 2B 0242 or 0244, or 0260
ki/A
XI. Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site Discuss
stormwater controls proposed in order to protect surface waters and wetlands downstream from
the property If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level
The construction of a new lamer bride will result in a 017 acre increase in impervious area
Appropriate erosion and sedimentation control measures will be in place during the bridge
replacement
XII. Sewage Disposal (required by DWQ)
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 7 of 8
X111. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H 0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application? Yes ? No
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
htti) /,1i2o enr state nc us 1Metlinds If no, please provide a short narrative description
The bridge replacement will not result in additional development of the surrounding area
XV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e g, draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control)
N/A
L /./J,
io-aq-r
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided )
Page 8 of 8
SR 1350, Rehobeth Church Road
Bridge #219, Cleveland County
Upstream

Bridge #219
Downstream
REVISIONS
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Figure 1
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NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division- 19 County Cleveland Project ID B-4469
River Basin Cleveland Bridge No Bridge #219
Route SR-1350
Water Quality Criteria.
Stream Brushy Creek
Stream Crossing Blue Line On USGS
ORW
WSI
WS 11,111 OR IV, Crossing Within 0.5cru of W S Critical Area
Roadway Criteria.
Route Designation-
Yes No
Arterial Urban r rv-
Arterial Rural r w
Additional Site Information
Yes No
Is a Hazardous Spill Basin Required? r r
Yes No
f V- r
F F
r r
r r
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997)