20191002 Ver 1_MCDC (Signed)_20190724

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.: n/a
State Project No: 17SP.14.R.72 (State Funded)
Structure No.: n/a
Project Location: SR 1618 (Glen Falls Road), Macon County
Project Description: This is a maintenance project to replace deteriorated existing
bridge (21' 3" L x 20' W timber floor on timber joist) with a new bridge structure (21" x
45' cored slab) over East Fork Overflow Creek (Class C; Tr.; ORW) in Macon County.
Anticipated Permit or Consultation Requirements:
1. Outside river corridor = Yes
2. Below impact threshold for applicable NWP = No, NWP 3.
3. Tree clearing = Yes (Follow Moratorium — Winter Clearing)
4. Trout watershed = Yes (Follow moratorium unless verification NCWRC letter
states no)
5. NLEB HUC = Clear (Not in Red HUC, more than 1.00 from Red HUC)
NWP 3 will require written authorization. Written 401 needed.
Special Project Information:
This project should have no effect on wetlands. Stringent erosion control measures will
be required since East Fork Overflow Creek is an Outstanding Resource Water.
The new bridge is being replaced in the footprint of the existing bridge w/in existing r/w.
07/22/19 1 of 4

PART A: MINIMUM CRITERIA
YES NO
Item I to be completed by the Engineer.
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
If either category #8, #12(1) or #15 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 Office
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 1-1 FN
Department of Interior's threatened and endangered species list?
7. Could the proposed activity cause significant changes in land use 1-1 FN
concentrations that would be expected to create adverse water quality or
ground water impacts?
07/22/19 2 of 4

YES NO
8. Is the proposed activity expected to have a significant adverse effect on ❑
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
to be completed by Division Environmental Officer.
YES NO
9. Is a federally protected threatened or endangered species, or its
❑ IN
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 & NCDWR 401
11. Does the project require the placement of a significant amount of
❑ IN
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
❑ IN
Concern, as defined in the coastal Area Management Act?
1Items 1W5 to be completed by the Er
13. Does the project require stream relocation or channel changes?
❑ IN
Cultural Resources
14. Will the project have an "effect" on a property or site listed on the ❑ IN
National Register of Historic Places?
15. Will the proposed action require acquisition of additional right of ❑ IN
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.
07/22/19 3 of 4

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]
DocuSigneed by:
d
Reviewed by: Q� V6(,LV 7/22/2019
F91746F43930471 __ Date:
NCDOT Division 14
Bridge Program Manager
Adam Dockery
D,.o�cuuS'i/g_neddt•by: I' �, I .
`lam ✓w(/I�WV -
A2DAC8979C7943D... Date:
Patrick J. Breedlove
Division 14 Environmental Specialist II
7/22/2019
07/22/19 4 of 4

Macon County
Replace Bridge No. 315 over East Fork Overflow Creek
SR 1618 (Glen Falls Road) near Franklin, N.C.
WBS No. 17BP.14.R.72
• NWP 3 will be required for this project. Written 401 will be required.
• Project will comply with the standard 2017 NWP 3 and 2017 GC 4132
conditions.
• Tree Clearing will occur during October 15' — April 15cn
• All in -stream aquatic impacts will occur during April 15t" — October
15t"
• Project will adhere to NCDOT best management practices due to project
being located within an Outstanding Resource Water.