20100797 Ver 1_Application_20100927

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Subject: Request for a NW 3 permit for pipe replacement on SR 1213 Herbert Perry Rd, Kitty Hawk, in
Dare County.
The North Carolina Department of Transportation is requesting a NW 3 permit for pipe
replacement on SR 1213 Herbert Perry Rd in Dare County. The pipe is located approximately 0.3 miles
from the intersection of SR 1206. The pipe will be removed using NCDOT best management practices for
pipe replacement. The current pipe, I @ 40'x 42" CMP will be replaced with I @ 40' x 48" CAP with
riprap on both ends. The pipes are located in an unnamed tributary to Kitty Hawk Bay. The PCN, vicinity
map, and permit drawings are included with this letter. If you need any additional information or have any
questions concerning this project please call me at 252-482-7977.
Sincerely,
a
STATE OF NORTH CAROLINA
ezk
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DEPARTMENT OF TRANSPORTATION arFq
BEVERLY EAVES PERDUE EUGENE A. CONrt, JR.
GOVERNOR SECRETARY
September 17, 2010
U.S. Army Corps of Engineers
Regulatory Field Office 100797
Post Office Box 1000 Washington, N.C. 27889-1000
Attention: Bill Biddlecome
Jerry Jennings
Division Engineer, Division gp?
Clay Willis J
Division One Environmental Officer
Wvi?
Cc: Garcy Ward, DWQ
Sonia Carillo, DWQ
113 Airport Drive, Suite 100, Edenton, NC 27932, Phone [phone], Fax [phone]

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Office Use Only:
Corps action ID no.
DWO project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
11. Processing
1 a. Type(s) of approval sought from the

Corps:
®Section 404 Permit El Section 10 Permit
1,b. Specify Nationwide Permit (NW P) number: NW 3 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 DW Q (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 1 h
below. ® Yes ? No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ® Yes ? No
2, Project Information
2'a. Name of project: SR 1213 Herbert Perry Rd pipe replacement
2!b. County: Dare
2c. Nearest municipality / town: Kitty Hawk
2d. Subdivision name:
2p. NCDOT only, T.I.P. or state
project no: State Project no: 1.20281
3. Owner Information
3!a. Name(s) on Recorded Deed: NCDOT
3b. Deed Book and Page No. n/a
3c. Responsible Party (for LLC if
applicable): NCDOT Division One
3d. Street address: 113 Airport Drive, Suite 100
3e. City, state, zip: Edenton, NC 27932
3f. Telephone no.: 252-482-5071
3g. Fax no.: 252-482-8722
3 h. Email address: [e-mail]
Page l of 10
PCN Form - Version 1.3 December 10, 2008 Version
I
4: Applicant Information (if different from owner)
4a. Applicant is: ? Agent ? Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5+ Agent/Consultant Information (if applicable)
5ia. Name:
5fi. Business name
I (if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
50. Email address:
Page 2 of 10
PCN Form - Version 1.3 December 10, 2008 Version

B! Project Information and Prior Project History
1.1 Property Identification
1a. Property identification no. (tax PIN or parcel ID):
I
1b. Site coordinates (in decimal degrees): Latitude: 36.06157 Longitude: - 75.70954
I (DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: 0.06 acres
21 Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to UT to Kitty Hawk Bay
proposed project:
2b. Water Quality Classification of nearest receiving water: SC
26. River basin: Pasquotank
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:
A secondary paved road with residential homes on the east and coastal marsh on the west that drains to Kitty Hawk Bay.
31i. List the total estimated acreage of all existing wetlands on the property:
< 1 acre
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
40
3d. Explain the purpose of the proposed project:
To replace a failing pipe on SR 1213.
3c:. Describe the overall project in detail, including the type of equipment to be used:
The existing 1 @ 40'X 42" corrugated metal pipe will be replaced with the proposed 1 @ 40'x 48" corrugated aluminum
pipe with riprap on both ends on its current alignment. The current pipe will be removed entirely. Proper fill will be used
to bring road to existing height. Heavy equipment that will be used will be an excavator, backhoe, and dump trucks. .
4. Jurisdictional Determinations
43. 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:
46. If the Corps made the jurisdictional determination, what type ? Preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
1
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.
1
6! Future Project Plans
66. Is this a phased project? ? Yes ® No
6I . If yes, explain.
Page 3 of 10
PCN Form - Version 1.3 December 10, 2008 Version
;,
C! Proposed Impacts Inventory
1.I Impacts summary
1a. Which sections were completed below for your project (check all that apply):
® Wetlands ? Streams - tributaries ? Buffers
? Open Waters ? Pond Construction
2.1 Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
26. 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 - non-404, other) (acres)
Tem ora T
W 1 ®P ? T fill (riprap) coastal ? Yes
Z No ® Corps
® DWQ 0.0004
W ? Yes ? Corps
2 ? P ? T ? No ? DWQ
? Yes ? Corps
W,3 ? P ? T ? No ? DWQ
W ? Yes ? Corps
4 ? P ? T ? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
? Yes ? Corps
W6 ? P ? T ? No ?DWQ
2t;. Total wetland impacts 0.0004
2h. Comments: There will be 16 sq. ft.of coastal wetland impact resulting from riprap around the ends of the pipe.
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.
Sit. 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
ITemporary (T) (INT)? other) (feet) feet)
1 ? PER ? Corps
S
1 ? P ? T ? INT ? DWQ
? PER ? Corps
S2 ? P ? T ? INT ? DWQ
? PER ? Corps
S3 ? P ? T ? INT ? DWQ
S4 ? P ? T ? PER ? Corps
1 ? INT ? DWQ
1 ? PER ? Corps
5 ? P ? T
S? ? INT ? DWQ
? PER ? Corps
S6 ? P ? T
I ? INT ? DWQ
3 h. Total stream and tributary impacts 0

3 i. Comments:
Page 4 of 10
PCN Form - Version 1.3 December 10, 2008 Version
i. I
4., Open Water Impacts
If Lhere 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.
44. 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
61 ?P?T
62 ?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.
56. 51b. 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
5c1. Comments:
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
5i, Expected pond surface area (acres):
Sj' 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 ? Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number -
I Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Tem ora T impact required?
IB1 ?P?T ?Yes
I ? No
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts
6( Comments:
Page 5 of 10
PCN Form - Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1 Avoidance and Minimization
16. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Pipe replacement is going to stay on the existing alignment and the road will be closed during construction. This will reduce
temporary impacts to wetlands and the stream by not using an on-site detour and keeping the road open..
16. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Methods of construction will be concurrent with NCDOT Best Management Practices for replacement of pipes and for soil and
erasion control .
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

2i;. 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:
31?. Credits Purchased (attach receipt and letter) Type Quantity
3h. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
411). Stream mitigation requested: linear feet
4r. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWO only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
43. Coastal (tidal) wetland mitigation requested: acres
41k. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form - Version 1.3 December 10, 2008 Version

6.1 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
6i. 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.

ZI one 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zdhe 2 1.5
6f. Total buffer mitigation required:
6q. 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).
6h. Comments:
Page 7 of 10
PCN Form - Version 1.3 December 10, 2008 Version

E.1 Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.1 Diffuse Flow Plan
1 al. 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? 0
n/a /o
2t1).
I Does this project require a Stormwater Management Plan? ® Yes ? No
2c1:.
I If this project DOES NOT require a Stormwater Management Plan, explain why:
2ci. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
NCDOT state stormwater permit for highway system is applicable. NCDOT will follow guidelines for Erosion and
Sediment Control.
? Certified Local Government
26 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 II
? NSW
3b. Which of the following locally-implemented stormwater management programs ? USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3%. Has the approved Stormwater Management Plan with proof of approval been F] Yes El No
attached?
4. DWQ Stormwater Program Review
? Coastal counties
? HOW
4a. Which of the following state-implemented stormwater management programs apply ? ORW
L1 Session Law 2006-246
check all that apply):
( ® Other: NCDOT stormwater
j
I permit, No. NCS000250
41b. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
5. DWQ 401 Unit Stormwater Review

I I
5a
. Does the Stormwater Management Plan meet the appropriate requirements?
? Yes ? No
1
5b
. Have all of the 401 Unit submittal requirements been met?
? Yes ? No
Page 8 of 10
PCN Form - Version 1.3 December 10, 2008 Version
I,

F.
i Supplementary Information
1. I 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.1 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
? Yes
? No
letter.)
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

I most recent DWQ policy. If you answered "no," provide a short narrative description.
4.
I 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.
No wastewater will be created from this project.
Page 9 of 10
PCN Form - Version 1.3 December 10, 2008 Version

1 >I
5. 1 ?
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 USFW S concerning Endangered Species Act ? Yes ®No
impacts?
j ? Raleigh
5c:. If yes, indicate the USFWS Field Office you have contacted. ? Asheville
50. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Natural Heritage database
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No
61b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Marine Fisheries
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)?
71b . What data sources did you use to determine whether your site would impact historic or archeological resources?
I
North Carolina Natural Heritage List
8. Flood Zone Designation (Corps Requirement)
3a . Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No
8b . If yes, explain how project meets FEMA requirements: Based on project scope, project was not reviewed for FEMA
requirements.
8c. What source(s) did you use to make the floodplain determination? NC Flood Mapping Information System
??
" g/21/?d
Clay Willis !?V
"

Applicant/Agent's Printed Name Applican gent's Signature
(Agent's signature is valid only if an authorization letter from the applicant Date
is rovided.
Page 10 of 10
PCN Form - Version 1.3 December 10, 2008 Version

Dare County SR 1213 Herbert Perry Rd
ipe replacement, 0.3 miles from SR 1206
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