20100414 Ver 1_Application_20100527

STATE OF NORTH CAROLINA
DEPARTMNT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
k4 y 2- v41
yam, 20/0
EUGENE A. CONTI, JR.
SECRETARY .
May 24, 2010
U.S. Army Corps of Engineers
Wilmington Regulatory Field Office
69 Darlington Avenue
Wilmington, North Carolina 28403
100414
ATTENTION: Mr. Brad Shaver
NCDOT Coordinator
SUBJECT: Nationwide 14 Permit Application for Secondary Road Improvement, SR 1422 (Blue Banks
Rd.), Brunswick County, WBS # 3C.010060
Dear Mr. Shaver:
Please find enclosed a PCN application from the North Carolina Department of Transportation for a Nationwide 14
permit for the secondary road improvement project on SR 1422 (Blue Banks Rd) in Brunswick County. The scope
of the project will be to widen, grade, drain and base the 2.0 mile of existing unpaved road to current NCDOT
secondary road standards of 20 feet of travel lanes and 6 feet of earthen shoulders to improve the roadway safety and
stability. Also enclosed are wetland data forms and maps for the issuance of a jurisdictional determination based on
our field review on February 17, 2010. As discussed, the jurisdictional determination form will be supplied to you
electronically.
By copy of this letter and enclosures, we are also requesting issuance of 401 Water Quality Certification 3820, from
the Division of Water Quality (DWQ). We have provided a method of debiting $240 to process the WQC permit
request, as noted in the subject line of this application.
If you have any questions or need any additional information, please feel free to contact me at [phone].
Sincerely,
Mason Herndon
Division 3 DEO
Enclosures
cc: w/ attachments
Mr. David Wainwright, DWQ Raleigh (7 copies)
124 DIVISION DRIVE, WILMINGTON, NC 28401
PHONE: [phone] FAx:[phone]
O?off W?A TE?9OG
Olqii? T
Office Use Only:
Corps action ID no.
DWQ project no.
Forth Version 1.3 Dec 10 2008
Pre-Construction Notification C Form
A. A Hcant Information
1. Processing
la. 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
1d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
le. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
? Yes ® No For the record only for Corps Permit:

? Yes ® No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes ® No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below. ® Yes ? No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ®No
2. Project Information
2a. Name of project: Blue Banks Loop Rd (SR 1422)
2b. County: Brunswick
2c. Nearest municipality / town: Northwest
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
project no: 3.010060
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
applicable): WA
3d. Street address: N/A
3e. City, state, zip: N/A
3f. Telephone no.: N/A
3g. Fax no.: N/A
3h. Email address: N/A
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: NCDOT Division 3 Engineer
4b. Name: H. Allen Pope
4c. Business name
(if applicable): North Carolina Department of Transportation
4d. Street address: 124 Division Dr.
4e. City, state, zip: Wilmington, NC 28401
4f. Telephone no.: 910-251-5724 "
4g. Fax no.., 910-251-5727
4h. Email address: N/A
5. Agent/Consultant Information (if applicable)
5a. Name: Mason Hemdon
5b. Business name
(if applicable): North Carolina Department of Transportation
5c. Street address: 124 Division Dr.
5d. City, state, zip: Wilmington, NC 28401
5e. Telephone no.: 910-251-5724
5f. Fax no.: 910-251-5727
5g. Email address: [e-mail]
Page 2 of 10
PCN Form - Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax PIN or parcel ID): N/A
1b. Site coordinates (in decimal degrees): Latitude: 34.34190 Longitude: - 78.13287
(DD.DDDDDD) - --(-DD.DDDDDD)
1c. Property size: N/A acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Grist Mill Branch
proposed project:
2b. Water Quality Classification of nearest receiving water: CSw
2c. River basin: Cape Fear
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:
Site is currently unpaved secondary road. General land use is agriculture, residence and forestry
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:
N/A
3d. Explain the purpose of the proposed project:
To improve the existing roadway by bringing it up to NCDOT standards to provide a better and safer roadway for
residents and school buses that utilize this facilty.
3e. Describe the overall project in detail, including the type of equipment to be used:
To widen, grade, drain, add base and stabilize the existing road to NCDOT secondary road standards to 20 ft. travel
lanes & 6 ft shoulders using standard road construction equipment.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
® Yes ? No ? Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
El Preliminary ®Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Mason Herndon Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Field verification: 2/17/10
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.
Page 3 of 10
PCN Form - Version 1.3 December 10,' 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. 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 - non404, other) (acres)
Temporary
W1 ®P ? T shoulder fill headwater forest ® Yes
? No ® Corps
? DWQ 0.07
W2 ®P ? T shoulder fill riverine swamp
forest ® Yes
? No ® Corps
? DWQ 0.01
W3 ? PEI T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWQ
W5 ? PEI T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts 0.08
2h. Comments: Impacts will occur at Site 1 8 2
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 pipe
removal/coffer
Grist Mill Branch ® PER
?INT ® Corps
®pWQ
9
10
dams
S2 ? P ? T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWO
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? PC] T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts 10
3i. Comments: Site 1 proposed pipe is 5.5 ft shorter than existing, temp impacts are for pipe removal and coffer dams for
dewatering, if required at time of construction.
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
Temporary T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes . ? No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
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 impacts require mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse ?Tor-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) or for Stream name mitigation (square feet) (square feet)
Tem ora T impact required?
B1 ?P?T ?Yes
? No
B2 ?P?T ?Yes
? No
B3 ?P?T
El ?Yes
No
6h. Total buffer impacts
6i. Comments:
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.
Side slopes designed at 3:1 or less. Headwalls included at stream crossing to reduce pipe length and stream impacts. No
new ditching in wetland area is proposed.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Strict implementation of sediment and erosion control BMP's will be utilized to protect waters of the US.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State? ? Yes ® No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation option will be used for this
project? ? Mitigation bank

? Payment to in-lieu fee program
? Permittee Responsible Mitigation
3. Complete If Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-Ileu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a pennittee responsible mitigation plan, provide a description of the proposed mitigation plan.
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
buffer mitigation? ? Yes ® No
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.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
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).
61h. Comments:
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:
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:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, na rrative description of the plan:
NCDOT's BMP's for Construction and Maintenance Activities will be utilized to manage stormwater runoff during
construction. Grass swales or alternative design will be used to the maximum extent possible in compliance with
NCDOT's NPDES permit No. 000250 Post Construction Stormwater Program.
? Cert ifled Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
® DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? N/A
? Phase 11
3b. Which of the following locally-implemented stormwater management programs ? NSW
? USMP
apply (check all that apply): N/A ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached? N/A
4. DWQ Stormwater Program 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? Per letter from DWQ dated 7/23/06, approval not required for this project. ? Yes ? No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? N/A ? Yes ? No
51b. Have all of the 401 Unit submittal requirements been met? N/A ? Yes ? No
Page 8 of 10
PCN Form -Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la . Does the project involve an expenditure of public (federal/state/local) funds or the ® Yes ? No
use of public (federal/state) land?
1b. 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)?
1c. 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:
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 2B .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):
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.
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 El Yes ®.No
impacts?
El 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?
Natural Heritage GIS data
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?
NC GIS data
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?
Project reviewed and cleared by NCDOT Human Environment Unit in coordination with State Historic Preservation office.
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? FEMA GIS data
Mason Herndon / .ate- ?? 5/17110
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant
is rovided.
Page 10 of 10
PCN Form - Version 1.3 December 10, 2008 Version

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