20190908 Ver 1_MCDC (Signed)_20190708

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.:
State Project No.: 17BP.14.R.176
Project Location: Bridge No. 276 on SR 1104 (Burnett Cove Road)
over Burnett Creek
Haywood County, North Carolina
Project Description: Replace Bridge No. 276 with a single span 45' x 2 1 " H cored slab
bridge structure at the existing location, near Waynesville, North Carolina. The project
will utilize stage construction methods during construction.
Anticipated Permit or Consultation Requirements: Nationwide Permit No. 3 & 401
Certification. Written notification is required for this project due to aquatic &
environmental impacts
1. Outside river corridor = Yes.
2. Below impact threshold for applicable NWP = No. NWP 3 Required.
3. Tree clearing = Yes (Maple, Locust, Hickory) — (follow moratorium).
4. Trout watershed = Yes (follow moratorium unless verification NCWRC letter
states no).
5. NLEB HUC = No. Greater than 0.25 miles from U.S. F & W NLEB "Red HUC".
Written USCAE 404 Permit & NCDWR 401 Permit and will follow NWP 3
conditions & NCDWR GC 4132 conditions.
Special Project Information:
The bridge and surrounding area were surveyed on 8.17.2018 and 3.25.2019 for bats rare
plants, respectively and no specimens or evidence were found. Potentially suitable habitat
near the bridge was intensively surveyed but on specimens were detected. Bridge to
bridge replacement.
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PART A: MINIMUM CRITERIA
YES NO
to be completed by the Engine
1. Is the proposed project listed as a type and class of activity allowed under 0
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? (9) Reconstruction of existing crossroad or
railroad separations and existing stream crossings,
including, but not limited to pipes, culverts, and
bridges.
If either category #8, #12(i) or 415 is used complete Part D of this checklist.
PART B: MINIMUM CRITERIA EXCEPTIONS
Items 2 — 4 to be completed by the Engineer
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 Officer
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?
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YES NO
8. Is the proposed activity expected to have a significant adverse effect on ❑ ES
long-term recreational benefits or shellfish, finfish, 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,&ffompleted 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? NWP 3/401 Cert. Required.
11. 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?
12. Is the proposed action located in an Area of Environmental ❑
Concern, as defined in the coastal Area Management Act?
Items 13 —15 to be completed by the Engineer.
13. Does the project require stream relocation or channel changes? ❑ �X
Cultural Resources
14. Will the project have an "effect" on a property or site listed on the 171 ❑X
National Register of Historic Places?
15. Will the proposed action require acquisition of additional right of 0
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.
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PART D: (To be completed when either category #8, #120), 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:
18. Project completion date:
19. Total acres of newly disturbed ground
surface:
20. Total acres of wetland impacts:
21. Total linear feet of stream impacts:
22. 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:
P 06& v� 7/8/2019
Reviewed by: F91746F43930471... Date:
Adam Dockery, PE
Division 14 Brid.&� Program Manager
DocuSig by:
7/8/2019
Date:
Patrick J. Breedlove
Division 14 - Environmental Specialist II
07/08/19 4 of 4

Haywood County
Replace Bridge No. 276 over Burnett Creek (Class: WS III; Tr.)
SR 1104 (Burnett Cove Road) near Waynesville, N.C.
WBS No. 17BP.14.R.176
• A written 404/401 permit is required and project will comply with the
standard 2017 NWP 3 and 2017 GC 4132 conditions.
• All tree removal will be completed during the approved "winter clearing"
moratorium months (October 15t" —April 15tn)
• No in -stream or work within 25 foot of Burnett Creek hall occur during
(October 15t" —April 15tn)
• Project is located within a trout watershed and will adhere to NCDOT best
management practices to prevent sedimentation into downstream habitats
in the Burnett Creek.