56362_NC DOT_20101228

1Y
CAMA / ❑ DREDGE & FILL Wb
GENERAL PERMIT ?, Previous permit#
❑New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
Applicant Name
Address
City
State ZIP
Phone # O
Fax # ( )
Authorized Agent
❑ CW
❑ EW ❑ PTA ❑ ES ❑ PTS
Affected
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no
PNA yes / no Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # () River Basin
Adj. Wtr. Body Lat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: )
Pier (dock) length
I _
Platform(s) j
Finger pier(s)
Groin length
number
Bulkhead/ Ripraplength
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
—
17-
I
I.
Shoreline Length _ ..
SAV: not sure yes no
Sandbags: not sure yes nor.
Moratorium: n/a yes no`
Photos: yes no
Waiver Attached: yes no
1
A building permit may be required by: ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s)
Check #
Permit Officer's Signature
Issuing Date
Local PlanningJurisdiction
Expiration Date
Rover File Name

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules ❑ Other:
❑ Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-796-7215) for more information on how to complywith these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

S�16AIVIA / E413REDGE & FILL NY 56362
GENERAL PERMIT Previous permit #
�;�<ew OModification ElComplete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC C',
Eg-Rules attached.
Applicant Name Project Location: County_
Address P, 14- �l; J�- 14 f O Street Address/ State Road/ Lot #(s)
Ci L State ZIP 1,4 13 -rp, i i
ty—
Phone # # Subdivision
I
Authorized Agent . City— L'�' /V ZIP
Affected E;4Cw Nlcw Cr7 PTA "S U PTS Phone# River Basin
AEC(s): 13 OEA [-1 HHF 0 1H El UBA El N/A Adj. Wtr. Bod fv J� ,,,
(n i,/unkn)
0 PWS: El FC:
ORW: yes /(-n� PNA yes / Do Crit.Halb. yes no Closest Maj. Wtr. Body
Jd
Type of Project/ Activity (L-,
i-A
ILL,
(Scale: 1u1 14
Pier (dock) length
Platform(s)
F- F
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
44
avg distance offshore
max distance offshore
Basin, channel
cubic yards
C4
1
ji.
T
!+
Boat ramp
Boathouse/ Boatlift
1
1 r
Beach Bulldozing
Other
Shoreline Length
SAV: not sure Yes Gn
Sandbags: not sure yes 00"
Moratorium: n/a yes 60/1
Photos: no
Waiver Attached: yes &
A building permit may be required by: ❑See note on back regarding River Basin rules.
Notes/ Special Conditions I
It
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
0 0
Application Fee(s) I Check #
Permit OfficeKs Signature
p--19
Issuing Date
Expiration Date
61
LL A
X I )--)s / 11,
Local Planninglurisdiction
Rover File Name

Aeio.lawA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
December 28, 2010
Clay Willis
NC DOT
113 Airport Dr., Suite 100
Edenton, NC 27932
Dear Mr. Willis:
Attached is General Permit #56362C to construct a 27'x47.6' bridge to replace the existing
20.5'x39' bridge located in Engelhard, NC.
In order to validate this permit, please sign the permit as indicated. Retain the white copy for
your files and return the signed yellow and pink copies to us in the enclosed, self-addressed
envelope. If the signed permit copies are not returned to this office before the initiation of
development, you will be working without authorization and will be subject to a Notice of
Violation and subsequent civil penalties.
We appreciate your early attention to this matter.
Sincerely,
Stephen Lane
Coastal Management Representative
lsb
Enclosures
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagement.not
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

I
�56�62
Applicant:
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq, Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp/ impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)_amount
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
b W"
Dredge ❑ Fill E / Both ❑ Other ❑
b
6
od—
Dredge [--r Fill ❑ Both ❑ Other ❑
6 O
�o
/
Dredge ❑ Fill ❑ Both ['Other [I.s—
�
O
�
Dredge ❑ Fill [KBoth ❑ Other ❑
!J,S k nRiJk
Dredge ❑ Fill ❑ Both [TOther ❑
6
Dredge [.Fill ❑ Both ❑ Other ❑
o D
,- /
Dredge ❑ Fill tK Both El Other ❑
r7
0
r/^
mf�
Dredge ❑ Fill ❑ Both [-Other ❑
3
D
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

s .5rA7Z
DEC 2 2010
ftiaiwud City XM
STATE OF NORTH CAROLMA
DEPARTMENT OF TRANSPORTATION
Beverly E. Purdue Gene Conti
GOVERNOR SECRETARY
December 1, 2010
Stephen Lane
NC Division of Coastal Management
400 Commerce Ave.
Morehead City, NC 28557
Dear Mr. Lane,
The NCDOT request the issuance of a General Permit .2300 for bridge
replacement # 13 on SR 1110 (Nebraska Rd) over Rattlesnake Canal in Hyde County.
The existing bridge is 39' x 20.5' wooden structure. The proposed bridge will be 47'-7
1/8" x 27' and be constructed with steel piles, concrete bents and cored slab concrete
deck. The bridge will be replaced on existing alignment, with an off -site detour. The
bridge spans Rattlesnake Canal, a tributary to Jeanette Creek, which is classified as Class
"SA, HQW" waters.
The Division of Coastal Management considers the project area to be within an
AEC that requires authorization for the pipe replacement. Included with this request are
the MP-1, MP-2, MP-5 forms, location map, landowner notices, and permit drawings
depicting the proposed work. The WBS element # is 1 C.048058. If any additional
information is needed please contact Clay Willis at 252-482-7977.
Sincerely,
Jerry Jennings, P.E.
Division Engineer, Division One
Clay Willis
Environmental Officer, Division One
113 Airport Dr., Suite 100, Edenton, NC 27932 — Phone: [phone] Fax: [phone]

ON MP-1
APPLICATION for
Major Development Permit
(last revised 12/27106)
North Carolina DIVISION OF COASTAL MANAGEMENT
1. Primary Applicant/ Landowner Information
Business Name
N.C. Department Of Transportation
Project Name (if applicable)
Bridge # 13 on SR 1110 (Nebraska Rd)
Applicant 1: First Name
Clay
MI
Last Name
Willis
Applicant 2: First Name
MI
Last Name
If additional applicants, please attach an additional page(s) with names listed.
Mailing Address
113 Airport Road, Suite 100
PO Box
City
Edenton
State
NC
ZIP
27932
Country
Phone No.
252 - 482 - 7977 ext.
FAX No.
252 - 482 - 8722
Street Address (if different from above)
City
State
ZIP
Email
2. Agent/Contractor Information
Business Name
Agent/ Contractor 1: First Name
MI
Last Name
Agent/ Contractor 2: First Name
MI
Last Name
Mailing Address
PO Box
City
State
ZIP
Phone No. 1
-
- ext.
Phone No. 2
- ext.
FAX No.
Contractor #
Street Address (if different from above)
City
State
ZIP
Email
<Form continues on back>

j f Form DCM MP-1 (Page 2 of 5)
APPLICATION for
Major Development Permit
3. Project Location
County (can be multiple)
Street Address
State Rd. #
Hyde
SR 1110, at the intersection of SR 1111
SR 1110
Subdivision Name
City
State
Zip
Engelhard
NC
t;.
27824 -
Phone No.
Lot No.(s) (if many, attach additional page with list)
- - ext.
a. In which NC river basin is the project located?
b. Name of body of water nearest to proposed project
Tar -Pamlico
Rattlesnake Canal
c. Is the water body identified in (b) above, natural or manmade?
d. Name the closest major water body to the proposed project site.
❑Natural ®Manmade ❑Unknown
Jeanette Creek
e. Is proposed work within city limits or planning jurisdiction?
f. If applicable, list the planning jurisdiction or city limit the proposed
❑Yes ®No
work falls within.
4. Site Description
a. Total length of shoreline on the tract (ft.)
b. Size of entire tract (sq.ft.)
100,
6000
c. Size of individual lot(s)
d. Approximate elevation of tract above NHW (normal high water) or
NWL (normal water level)
(if many lot sizes, please attach additional page with a list)
4 ❑NHW or ®NWL
e. Vegetation on tract
Various roadside grasses on a maintained shoulder, spartina patens, spartina alterniflora, distichlis spicata .
f. Man-made features and uses now on tract
SR 1110 Nebraska Rd
g. Identify and describe the existing land uses adjacent to the proposed project site.
Adjacent land use is rural residential and agricultural.
h. How does local government zone the tract?
I. Is the proposed project consistent with the applicable zoning?
N/A
(Attach zoning compliance certificate, if applicable)
[]Yes ❑No ®NA
j. Is the proposed activity part of an urban waterfront redevelopment proposal? ❑Yes ®No
k. Hasa professional archaeological assessment been done for the tract? If yes, attach a copy. ❑Yes ®No ❑NA
If yes, by whom?
I. Is the proposed project located in a National Registered Historic District or does it involve a ❑Yes ®No ❑NA
National Register listed or eligible property?
<Form continues on next page>
m. (i) Are there wetlands on the site? ®Yes []No
(ii) Are there coastal wetlands on the site? ®Yes [:]No
(iii) If yes to either (i) or (ii) above, has a delineation been conducted? ®Yes ❑No
(Attach documentation, if available)
252-808--230 ., t..888-4RCOAST .. www.aiccoastainaanagement.net

t
Form DCM MP-1 (Page 3 of 5)
APPLICATION for
Major Development Permit
n. Describe existing wastewater treatment facilities.
None
o. Describe existing drinking water supply source.
None
p. Describe existing storm water management or treatment systems.
None
5. Activities and Impacts
a. Will the project be for commercial, public, or private use? ❑Commercial ®Public/Government
❑Private/Community
b. Give a brief description of purpose, use, and daily operations of the project when complete.
Provide safe transportation along SR 1110 by maintaining an existing bridge crossing over Rattlesnake Canal.
c. Describe the proposed construction methodology, types of construction equipment to be used during construction, the number of each type
of equipment and where it is to be stored.
The bridge will be replaced using top down construction techniques. The new bridge will be replaced on its existing
alignment. The bridge will be constructed with cored slab concrete using a crane, excavator, dumptrucks and various other
types of equipment.
d. List all development activities you propose.
The existing 39' x 20.5' wooden bridge will be entirely removed using NCDOT guidelines for bridge removal. The new bridge
will be 47'-7 1/8" x 27'. The new bridge will consist of 1 concrete span supported by concrete bents and steel piles. This
bridge will be replaced on the existing alignment, causing a temporary road closure. Traffic will be detoured by using an off -
site detour route. Driveway pipes on the northeast and southeast side of the bridge will be replaced and the driveways
widened in order to accommodate proposed guardrail. Northeast, existing pipe is 20' x 18" RCP and proposed is 40' x 18"
CAP. Southeast, existing pipe is 32' x 18" RCP and proposed is 40' x 18" CAP. Riprap will be placed at the toe of the slope
around both of the proposed end bents. A cross -line will be replaced under SR 1111 on the southwest comer of the bridge
in order to accommodate the proposed wingwall at this same location. The existing pipe is 42' x 24" RCP and proposed is
45' x 24" CAP.
e. Are the proposed activities maintenance of an existing project, new work, or both? Maintenance of an existing bridge.
f. What is the approximate total disturbed land area resulting from the proposed project? 1500 ®Sq.Ft or ❑Acres
g. Will the proposed project encroach on any public easement, public accessway or other area ❑Yes ®No ❑NA
that the public has established use of?
h. Describe location and type of existing and proposed discharges to waters of the state.
Surface runoff from SR 1110.
I. Will wastewater or stormwater be discharged into a wetland? ❑Yes ®No ❑NA
If yes, will this discharged water be of the same salinity as the receiving water? []Yes [:]No ❑NA
j. Is there any mitigation proposed? []Yes ®No ❑NA
If yes, attach a mitigation proposal.
<Form continues on back>
6. Additional Information
In addition to this completed application form, (MP-1) the following items below, if applicable, must be submitted in order for the application
package to be complete. Items (a) — (0 are always applicable to any major development application. Please consult the application
instruction booklet on how to properly prepare the required items below.
a. A project narrative.
ti;

Ferm DCM MP-1 (Page 4 of 5)
APPLICATION for
Major Development Permit
b. An accurate, dated work plat (including plan view and cross -sectional drawings) drawn to scale. Please give the present status of the .-
proposed project. Is any portion already complete? If previously authorized work, clearly indicate on maps, plats, drawings to distinguitfx�
between work completed and proposed.
c. A site or location map that is sufficiently detailed to guide agency personnel unfamiliar with the area to the site. C�
d. A copy of the deed (with state application only) or other instrument under which the applicant claims title to the affected properties.
e. The appropriate application fee. Check or money order made payable to DENR.
f. A list of the names and complete addresses of the adjacent waterfront (riparian) landowners and signed return receipts as proof that such
owners have received a copy of the application and plats by certified mail. Such landowners must be advised that they have 30 days in
which to submit comments on the proposed project to the Division of Coastal Management.
Name Lamar Spencer
Phone No.
Address 6491 NC 94
Fairfield, NC 27826
Name E.T. Sawyer
Phone No.
Address P.O. Box 275
Pantego, NC 27860
Name James Midyette, Jr.
Phone No.
Address 618 Lowe Drive
FT. Leavenworth, KS 66027
Name Rhoda J. Midyette
Address 618 Lowe Drive
FT. Leavenworth, KS 66027
g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, permittee, and issuing dates.
h. Signed consultant or agent authorization form, if applicable.
i. Wetland delineation, if necessary.
j. A signed AEC hazard notice for projects in oceanfront and inlet areas. (Must be signed by property owner)
k. A statement of compliance with the N.C. Environmental Policy Act (N.C.G.S. 113A 1-10), if necessary. If the project involves expenditure
of public funds or use of public lands, attach a statement documenting compliance with the North Carolina Environmental Policy Act.
7. Certification and Permission to Enter on Land
I understand that any permit issued in response to this application will allow only the development described in the application.
The project will be subject to the conditions and restrictions contained in the permit.
0
2 5 2 - 8 0 8 - 2 8 0 8 .. 1-888-4RCOAST ,. +nvvw.ne coastalmanargement.net

Form DCM MP-1 (Page 5 of 5)
APPLIttPermji
for
Major Deve
�i� men,
I certify that I am authorized to grant, and do in fact grant permission to representatives of state and federal review agencies to
enter on the aforementioned lands in connection with evaluating information related to this permit application and follow-up
monitoring of the project.
I further certify that the information provided in this application is truthful to the best of my knowledge.
Date t' \ \ a_ � \ p Print Name
Signature
_Clay Willis, Environmental Officer.
Please indicate application attachments pertaining to your proposed project.
®DCM MP-2 Excavation and Fill Information ®DCM MP-5 Bridges and Culverts
❑DCM MP-3 Upland Development
❑DCM MP-4 Structures Information
252-808-2608 . 1-888-4R OA - vvww.r�cctsast lrrr rates ers �st,r�

Form DCM MP-2
.00^
EXCAVATION and FILL �`
(Except for bridges and culverts)%
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of the Joint �".
Application that relate to this proposed project. Please include all supplemental information.
Describe below the purpose of proposed excavation and/or fill activities. All values should be given in feet.
Access
Other
Channel
(NLW or
Canal
Boat Basin
Boat Ramp
Rock Groin
Rock
Breakwater
(excluding
shoreline
NW L)
stabilization
Length
Width
Avg. Existing
NA
NA
Depth
Final Project
NA
NA
Depth
1. EXCAVATION ®This section not applicable
a. Amount of material to be excavated from below NHW or NWL in b. Type of material to be excavated.
cubic yards.
c. (i) Does the area to be excavated include coastal wetlands/marsh
(CW), submerged aquatic vegetation (SAV), shell bottom (SB),
or other wetlands (WL)? If any boxes are checked, provide the
number of square feet affected.
[:]CW ❑SAV ❑SB
OWL ❑None
(ii) Describe the purpose of the excavation in these areas:
d. High -ground excavation in cubic yards.
2. DISPOSAL OF EXCAVATED MATERIAL ®This section not applicable
a. Location of disposal area. b. Dimensions of disposal area.
c. (i) Do you claim title to disposal area?
❑Yes ❑No ❑NA
(ii) If no, attach a letter granting permission from the owner.
d. (i) Will a disposal area be available for future maintenance?
❑Yes ❑No ❑NA
(ii) If yes, where?
e. (i) Does the disposal area include any coastal wetlands/marsh f. (i) Does the disposal include any area in the water?
(CW), submerged aquatic vegetation (SAV), shell bottom (SB), []Yes []No DNA
or other wetlands (WL)? If any boxes are checked, provide the (ii) If yes, how much water area is affected?
number of square feet affected.
❑CW ❑SAV ❑SB
OWL ❑None
(ii) Describe the purpose of disposal in these areas:
3. SHORELINE STABILIZATION ❑This section not applicable
(if development is a wood groin, use MP-4 — Structures)
"a?-S ti-2808 :: Y-888-4RCOAST ,: reviser!. 121"26,'0

1 �
f4 DGINIP-2 ,It. xf, �t,,;'i ion alid Fitt, Page 2 at 2)
a. Type of shoreline stabilization: b. Length: 86 ft. ©�,
❑Bulkhead ®Riprap ❑Breakwater/Sill ❑Other:
Width: 2 ft.
c. Average distance waterward of NHW or NWL: 2'. d. Maximum distance waterward of NHW or NWL: 3'
e. Type of stabilization material: f. (i) Has there been shoreline erosion during preceding 12
Class B Rip -Rap months?
❑Yes ®No ❑NA
(ii) If yes, state amount of erosion and source of erosion amount
information.
g. Number of square feet of fill to be placed below water level. h. Type of fill material.
Bulkhead backfill Riprap 65.33 So. ft. Rip -Rap
Breakwater/Sill Other
i. Source of fill material.
commercial
4. OTHER FILL ACTIVITIES ®This section not applicable
(Excluding Shoreline Stabilization)
a. (i) Will fill material be brought to the site? ❑Yes ❑No ❑NA b. (i) Will fill material be placed in coastal wetlands/marsh (CW),
If yes,
(ii) Amount of material to be placed in the water
(iii) Dimensions of fill area
(iv) Purpose of fill
submerged aquatic vegetation (SAV), shell bottom (SB), or
other wetlands (WL)? If any boxes are checked, provide the
number of square feet affected.
❑CW ❑SAV ❑SB
❑WL ❑None
(ii) Describe the purpose of the fill in these areas:
15. GENERAL
a. How will excavated or fill material be kept on site and erosion b. What type of construction equipment will be used (e.g., dragline,
controlled? backhoe, or hydraulic dredge)?
NCDOT BMP's for soil and erosion control crane, excavator, dump trucks, backhoe
c. (i) Will navigational aids be required as a result of the project?
❑Yes ®No ❑NA
(ii) If yes, explain what type and how they will be implemented.
/iQ // O
Date I'
Bridge # 13 on SR 1110 (Nebraska Rd)
Project Name
P
plicant Name
d. (i) Will wetlands be crossed in transporting equipment to project
site? []Yes ®No []NA
(ii) If yes, explain steps that will be taken to avoid or minimize
environmental impacts.
plicant Signature
62 8i 8-a6(i8 ;. 1-888-4RLC; SST ;: wwvw.ncaccrlastairatanagemen t.net revised. 1 2 /06

Farm DCM MP-5
BRIDGES and CULVERTS P���9r
a� o
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of the Ant
Application that relate to this proposed project. Please include all supplemental information.
1. BRIDGES ❑This section not applicable
a. Is the proposed bridge: b. Water body to be crossed by bridge:
❑Commercial ®Public/Government ❑Private/Corn munity Rattlesnake Canal, which is a tributary to Jeannette Creek
c. Type of bridge (construction material): d. Water depth at the proposed crossing at NLW or NWL:
single span cored slab concrete bridge 3 feet
e. (i) Will proposed bridge replace an existing bridge? ®Yes ❑No f. (i) Will proposed bridge replace an existing culvert? []Yes ®No
If yes, If yes,
(ii) Length of existing bridge: 39 ft. (ii) Length of existing culvert: n/a
(iii) Width of existing bridge: 20.5 ft. (iii) Width of existing culvert: n/a
(iv) Navigation clearance underneath existing bridge: 1.5 ft. (iv) Height of the top of the existing culvert above the NHW or
(v) Will all, or a part of, the existing bridge be removed? NWL: n/a
(Explain) All of the existing bridge will be removed (v) Will all, or a part of, the existing culvert be removed?
and replaced with a new structure (Explain) n/a
9• Length of proposed bridge: 47' - 7 1/8" ft. h. Width of proposed bridge: 27 ft.
i. Will the proposed bridge affect existing water flow? ®Yes ❑No j. Will the proposed bridge affect navigation by reducing or
If yes, explain: The new bridge is longer, which increases increasing the existing navigable opening? ❑Yes ®No
hydraulic opening. If yes, explain:
k. Navigation clearance underneath proposed bridge: 1.5 ft. I. Have you contacted the U.S. Coast Guard concerning their
approval? ❑Yes ®No
If yes, explain: n/a
m. Will the proposed bridge cross wetlands containing no navigable n. Height of proposed bridge above wetlands: n/a
waters? ❑Yes ®No
If yes, explain:
2. CULVERTS ®This section not applicable
a. Number of culverts proposed: n/a b. Water body in which the culvert is to be placed:
< Form continues on back>
c. Type of culvert (construction material):
2S2-808-2808 ;: 1-8 f3-*tRf' AST revised: 10126ii78

Ft_401 DCPO, - ( ridges, anci Culverts, Pa9e 2 of 4)
d. (i) Will proposed culvert replace an existing bridge?
❑Yes []No
If yes,
(ii) Length of existing bridge:
(iii) Width of existing bridge:
(iv) Navigation clearance underneath existing bridge:
(v) Will all, or a part of, the existing bridge be removed?
(Explain)
f• Length of proposed culvert:
h. Height of the top of the proposed culvert above the NHW or NWL.
j. Will the proposed culvert affect navigation by reducing or
increasing the existing navigable opening? ❑Yes []No
If yes, explain:
64' 'aC'aa
e. (i) Will proposed culvert replace an existing culvert?
"4%pYes ❑I�
If yes,
(ii) Length of existing culvert(s):°jtf
(iii) Width of existing culvert(s): _44
(iv) Height of the top of the existing culvert above the NHW or
NWL:
(v) Will all, or a part of, the existing culvert be removed?
(Explain)
9. Width of proposed culvert:
I. Depth of culvert to be buried below existing bottom contour.
k. Will the proposed culvert affect existing water flow?
❑Yes ❑No
If yes, explain:
13. EXCAVATION and FILL [I This section not applicable J
a. (i) Will the placement of the proposed bridge or culvert require any b. (i) Will the placement of the proposed bridge or culvert require any
excavation below the NHW or NWL? ®Yes ❑No excavation within coastal wetlands/marsh (CW), submerged
If yes, aquatic vegetation (SAV), shell bottom (SB), or other wetlands
(WL)? If any boxes are checked, provide the number of square
(ii) Avg. length of area to be excavated: 80' feet affected.
(iii) Avg. width of area to be excavated: 2' ®CW 106.52 so. ft. ❑SAV ❑SB
(iv) Avg. depth of area to be excavated: 2' ❑WL []None
(v) Amount of material to be excavated in cubic yards: 11.9
c. (i) Will the placement of the proposed bridge or culvert require any
high -ground excavation? ®Yes [:]No
If yes,
(ii) Avg. length of area to be excavated: 40'
(iii) Avg. width of area to be excavated: 15'
(iv) Avg. depth of area to be excavated: 3'
(v) Amount of material to be excavated in cubic yards: 66.7
(ii) Describe the purpose of the excavation in these areas:
Temporary impacts associated with the removal and
relocation of a dry fire hydrant located on the northwest
comer of the bridge.
revised:

d. If the placement of the bridge or culvert involves any excavation, please complete the following:
(i) Location of the spoil disposal area: approved NCDOT waste site
N >B
(ii) Dimensions of the spoil disposal area: n/a .
(iii) Do you claim title to the disposal area? CKYes ❑No (If no, attach a letter granting permission from the owner.)
(iv) Will the disposal area be available for future maintenance? ®Yes ❑No
(v) Does the disposal area include any coastal wetlands/marsh (CW), submerged aquatic vegetation (SAVs), other wetlands (WL), or shell
bottom (SB)?
❑CW ❑SAV OWL ❑SB ®None
If any boxes are checked, give dimensions if different from (ii) above.
(vi) Does the disposal area include any area below the NHW or NWL? ? ❑Yes ®No
If yes, give dimensions if different from (ii) above.
e. (i) Will the placement of the proposed bridge or culvert result in any
fill (other than excavated material described in Item d above) to
be placed below NHW or NWL? ®Yes []No
If yes,
(ii) Avg. length of area to be filled: 86'
(iii) Avg. width of area to be filled: 2'
(iv) Purpose of fill: riprap for bank stabilization
g. (i) Will the placement of the proposed bridge or culvert result in any
fill (other than excavated material described in Item d above) to
be placed on high -ground? ®Yes [:]No
If yes,
(ii) Avg. length of area to be filled: 43
(iii) Avg. width of area to be filled: 19
(iv) Purpose of fill: roadway approaches, shoulder
reconstruction
(i) Will the placement of the proposed bridge or culvert result in any
fill (other than excavated material described in Item d above) to
be placed within coastal wetlands/marsh (CW), submerged
aquatic vegetation (SAV), shell bottom (SIB), or other wetlands
(WL)? If any boxes are checked, provide the number of square
feet affected.
®CW 232.70 so. ft. ❑SAV ❑SB
❑WL ❑None
(ii) Describe the purpose of the excavation in these areas:
Riprap being placed at toe of slope around end bents
for slope protection. Fill associated with driveway pipe
replacements and driveways widened in order to
accommodate guardrail on the northeast and southeast
side of bridge. Fill associated with a cross -line being
replaced under SR 1111 on the southwest corner of
bridge in order to accommodate the proposed wingwall
at this same location.
4. GENERAL
a. Will the proposed project require the relocation of any existing b. Will the proposed project require the construction of any temporary
utility lines? ❑Yes ®No detour structures? ❑Yes ®No
If yes, explain: If yes, explain:
If this portion of the proposed project has already received
approval from local authorities, please attach a copy of the
approval or certification.
< Form continues on back>

(Bridges♦ CnIverts, Page 4 of
c. Will the proposed project require any work channels? d
❑Yes ®No
If yes, complete Form DCM-MP-2.
e. What type of construction equipment will be used (for example, f.
dragline, backhoe, or hydraulic dredge)?
crane, excavator, backhoe, dumptrucks
g. Will the placement of the proposed bridge or culvert require any
shoreline stabilization? ®Yes ❑No
If yes, complete form MP-2, Section 3 for Shoreline
Stabilization only.
Date
Bridge # 13 on SR 1110 (Nebraska Rd)
Project Name
,`�
r
plicant Name
Clay Willis - NCDOT Division 1
plicant Signature
How will excavated or fill material be kept on site and ero
controlled?F'o�
NCDOT BMP's & guidelines for Soil and Erosion Control
a
rr
Will wetlands be crossed in transporting equipment to project site?
❑Yes ®No
If yes, explain steps that will be taken to avoid or minimize
environmental impacts.
y, 6

Hyde Co. Bridge # 13 on SR 1110 Nebraska Rd
intersection of SR 1110 & SR 1111
1314 - 77S
FE REFUC;E '
FrWelAaii I IL�}�w,] FAb
�4 M
44
, 3
I ^ .
3
Bridge # 13 73i1 BD
35.466703-
- 76.036364
i gym'
I Is �L9fM Ol B�' I \
-
/ MIDDLffiTOW7
.�
�- Go
i
I
1 ,
Y
l
1 I X_ _
la t Chance _ _ �_ _� -.. �. Ahite Fta - II
21
_
- - - -
USGS Quad - Middletown N
Tar -Pamlico River Basin 0 0.25 0.5 1 Miles W E
S

PLAN VIE �F� 2 2010
DETAILED nl?A WING'i'mciiv,
BRIDGE #13 HYDE COUNTY
LAMAR SPEA'CER /
\ \ \ 6491 NC94
\ \ \ A \ FAIRFIELD, NC 27826 /
\ \\ \ EXISTING BRIDGE
DRSRNY &AN . FOR EXIST. 3 9' x 2 0.5' (T O BE REMOVED)
_REA T 2
REVISIONS
REVISED
11-08-10
REVISED
11-04-10
REVISED
10-28-10
REVISED
09-14-10
REVISED
07-12 10
M
\ � \ REA 00
AREA .11
\ \ ~ E%I5T ORY RY�RANT TO BE PLC TEMPORARY IMPACT
AT NEw LOCe ION.
RHODA J. MIDYETTE \ �` All��/ AREA
618 LOWE DRIVE �eRoP'\ap9N s•ae AREA "T-1" HAS 53.26 SQ. FT. OF TEMPORARY IMPACT
FT. LEAVENWORTH, KS 66027 \ �° AREA S" / / \ o s 2*�� AREA "T-2" HAS 53.26 SQ. FT. OF TEMPORARY IMPACT
,J Bey REASw-i' CC \\ PROJECT TOTAL = 106.52 SQ. FT. OF TEMPORARY IMPACT
RE
i
PROPOSED BRIDGE = 47 -71�8rr x 27r -0rr ( 24r -10n CLEAR ROADWAY )
E. T. BOXY R �� = WETLAND IMPACT
75
PANTEGO, NC 27860
AREA "AA" HAS 20.86 SQ. FT. OF WETLAND IMPACT
AREA "BB" HAS 34.05 SQ. FT. OF WETLAND IMPACT
AREA "CC" HAS '158.26 SO. FT. OF WETLAND IMPACT
AREA "DID" HAS 19.53 SQ. FT. OF WETLAND IMPACT
PROJECT TOTAL = 232.70 SQ. FT. OF WETLAND IMPACT
J 18 LOWE DRIVE NORTH \ \ \ \ NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
FT. LEAVENWORTH, KS 66027 DIVISION 1
= SURFACE WATER IMPACT \ \
AREA "SW-1" HAS 19.38 SO. FT. OF SURFACE WATER IMPACT
AREA "SW-2" HAS 45.95 SQ. FT. OF SURFACE WATER IMPACT
PROJECT TOTAL = 65.33 SQ. FT. OF SURFACE WATER IMPACT \�

SYMBOLS
PROPOSED CROSS SECTION
EXISTING CROSS SECTION
27'-0' '
24'-10' CLlAR ROADWAY
17

a„a STA7F o
®,®
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Beverly Eaves Purdue Gene Conti
GOVERNOR SECRETARY
November 12, 2010
Lamar Spencer CERTIFIED MAIL
6491 NC 94
Fairfield, NC 27826
To Whom It May Concern:
The NC Department of Transportation is proposing to replace Bridge # 13 on SR
1110 (Nebraska Rd.). The existing bridge is 20.5 ft. wide X 39 ft. long single span
structure composed of a timber deck with an asphalt surface. The substructure is timber
pilings with wooden beam girders. The proposed bridge is 27 ft. wide X 47' — 7 1/8"
long. The new structure will be a precast concrete deck supported by a concrete and steel
substructure. This bridge will be replaced on its existing alignment. The road will be
closed to traffic and a temporary detour established during the time of construction.
The Division of Coastal Management (DCM) considers the waters at this location
to be "Public Trust & Estuarine" under their regulations. Therefore, it is provided
protection under state law. For this reason the NCDOT will apply for a permit from the
DCM to perform the described work. Part of the permit process is notifying the adjacent
landowners of the proposed work. A map depicting the project area, along with a design
plat and permit application is included with this letter. If you have any questions
concerning the proposed work you can contact Clay Willis at 252-482-7977.
113 Airport Dr., Suite 100, Edenton, NC 27932 — Phone: [phone] Fax: [phone]

y
k
The attached form is submitted to insure that you have an opportunity to coip men
on the proposal. The work is depicted on the attached drawings. If you have no objec`,
the proposal, please return the form with your response within ten (10) days to this office. 0-11
If you do have objections to the project, please forward your comments to: ;'tf
Stephen Lane
NC Division of Coastal Management
400 Commerce Ave
Morehead City, NC 28557
No response within ten (10) days will be construed to mean you have no objections.
Thank you for your cooperation.
Sincerely,
Jerry Jennings, P.E.
Division Engineer, Division One
Clay Willis
Environmental Officer, Div 'on One
113 Airport Dr., Suite 100, Edenton, NC 27932 —Phone: [phone] Fax: [phone]

L P-6*
e61 �QI
1
ADJACENT RIPARIAN LANDOWNER STATEMENT ���41 l0
(14
(Hyde: Bridge # 13 on SR 1110 (Nebraska Rd)
I, , am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the pipe
replacement on SR 1110 (Nebraska Rd). I am further aware that this work will occur in
an AEC and therefore will require authorization from the Division of Coastal
Management in accordance with the Coastal Area Management Act (CAMA).
I have no objection to the project as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
are attached.
I have objections to the project as presently proposed and my comments
Signature of Adjacent Landowner
Date:

0
STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Beverly Eaves Purdue Gene Conti
GOVERNOR SECRETARY
November 12, 2010
E.T. Sawyer CERTIFIED MAIL
P.O. Box 275
Pantego, NC 27860
To Whom It May Concern:
The NC Department of Transportation is proposing to replace Bridge # 13 on SR
1110 (Nebraska Rd.). The existing bridge is 20.5 ft. wide X 39 ft. long single span
structure composed of a timber deck with an asphalt surface. The substructure is timber
pilings with wooden beam girders. The proposed bridge is 27 ft. wide X 47' — 7 1 /8"
long. The new structure will be a precast concrete deck supported by a concrete and steel
substructure. This bridge will be replaced on its existing alignment. The road will be
closed to traffic and a temporary detour established during the time of construction.
The Division of Coastal Management (DCM) considers the waters at this location
to be "Public Trust & Estuarine" under their regulations. Therefore, it is provided
protection under state law. For this reason the NCDOT will apply for a permit from the
DCM to perform the described work. Part of the permit process is notifying the adjacent
landowners of the proposed work. A map depicting the project area, along with a design
plat and permit application is included with this letter. If you have any questions
concerning the proposed work you can contact Clay Willis at 252-482-7977.
113 Airport Dr., Suite 100, Edenton, NC 27932 — Phone: [phone] Fax: [phone]

1 , f
• ,
The attached form is submitted to insure that you have an opportunity to commentAFC-2 2010
on the proposal. The work is depicted on the attached drawings. If you have no objects-tQJ;�
the proposal, please return the form with your response within ten (10) days to this office. �4%)C4
If you do have objections to the project, please forward your comments to:
Stephen Lane
NC Division of Coastal Management
400 Commerce Ave
Morehead City, NC 28557
No response within ten (10) days will be construed to mean you have no objections.
Thank you for your cooperation.
Sincerely,
Jerry Jennings, P.E.
Division Engineer, Division One
Clay Willis ffi2)-
Environmental Officer, Division One
113 Airport Dr., Suite 100, Edenton, NC 27932 — Phone: [phone] Fax: [phone]

ADJACENT RIPARIAN LANDOWNER STATEMENT' OFC, 2 �Q1
(Hyde: Bridge # 13 on SR 1110 (Nebraska Rd)
I, , am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the pipe
replacement on SR 1110 (Nebraska Rd). I am further aware that this work will occur in
an AEC and therefore will require authorization from the Division of Coastal
Management in accordance with the Coastal Area Management Act (CAMA).
I have no objection to the project as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
are attached.
I have objections to the project as presently proposed and my comments
Signature of Adjacent Landowner
Date:

DEC 2010
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Beverly Eaves Purdue Gene Conti
GOVERNOR SECRETARY
November 12, 2010
James Midyette, Jr. CERTIFIED MAIL
618 Lowe Drive
FT. Leavenworth, KS 66027
To Whom It May Concern:
The NC Department of Transportation is proposing to replace Bridge # 13 on SR
1110 (Nebraska Rd.). The existing bridge is 20.5 ft. wide X 39 ft. long single span
structure composed of a timber deck with an asphalt surface. The substructure is timber
pilings with wooden beam girders. The proposed bridge is 27 ft. wide X 47' — 7 1/8"
long. The new structure will be a precast concrete deck supported by a concrete and steel
substructure. This bridge will be replaced on its existing alignment. The road will be
closed to traffic and a temporary detour established during the time of construction.
The Division of Coastal Management (DCM) considers the waters at this location
to be "Public Trust & Estuarine" under their regulations. Therefore, it is provided
protection under state law. For this reason the NCDOT will apply for a permit from the
DCM to perform the described work. Part of the permit process is notifying the adjacent
landowners of the proposed work. A map depicting the project area, along with a design
plat and permit application is included with this letter. If you have any questions
concerning the proposed work you can contact Clay Willis at 252-482-7977.
113 Airport Dr., Suite 100, Edenton, NC 27932 — Phone: [phone] Fax: [phone]

i r
The attached form is submitted to insure that you have an opportunity torlml�" i01�
on the proposal. The work is depicted on the attached drawings. If you have no objects to
the proposal, please return the form with your response within ten (10) days to this office:`'' `cifyoco
If you do have objections to the project, please forward your comments to:
Stephen Lane
NC Division of Coastal Management
400 Commerce Ave
Morehead City, NC 28557
No response within ten (10) days will be construed to mean you have no objections.
Thank you for your cooperation.
Sincerely,
Jerry Jennings, P.E.
Division Engineer, Division One
Clay Willis �Va
Environmental Officer, Division One
113 Airport Dr., Suite 100, Edenton, NC 27932 — Phone: [phone] Fax: [phone]

DEC 2 nio
ADJACENT RIPARIAN LANDOWNER STATEMENT firgwejjLudrilv�t��w
(Hyde: Bridge # 13 on SR 1110 (Nebraska Rd)
I, , am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the pipe
replacement on SR 1110 (Nebraska Rd). I am further aware that this work will occur in
an AEC and therefore will require authorization from the Division of Coastal
Management in accordance with the Coastal Area Management Act (LAMA).
I have no objection to the project as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
are attached.
I have objections to the project as presently proposed and my comments
Signature of Adjacent Landowner
Date:
11

. , V
d sa STAT,
STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Beverly Eaves Purdue Gene Conti
GOVERNOR SECRETARY
November 12, 2010
Rhoda J. Midyette CERTIFIED MAIL
618 Lowe Drive
FT. Leavenworth, KS 66027
To Whom It May Concern:
The NC Department of Transportation is proposing to replace Bridge # 13 on SR
1110 (Nebraska Rd.). The existing bridge is 20.5 ft. wide X 39 ft. long single span
structure composed of a timber deck with an asphalt surface. The substructure is timber
pilings with wooden beam girders. The proposed bridge is 27 ft. wide X 47' — 7 1 /8"
long. The new structure will be a precast concrete deck supported by a concrete and steel
substructure. This bridge will be replaced on its existing alignment. The road will be
closed to traffic and a temporary detour established during the time of construction.
The Division of Coastal Management (DCM) considers the waters at this location
to be "Public Trust & Estuarine" under their regulations. Therefore, it is provided
protection under state law. For this reason the NCDOT will apply for a permit from the
DCM to perform the described work. Part of the permit process is notifying the adjacent
landowners of the proposed work. A map depicting the project area, along with a design
plat and permit application is included with this letter. If you have any questions
concerning the proposed work you can contact Clay Willis at 252-482-7977.
113 Airport Dr., Suite 100, Edenton, NC 27932 — Phone: [phone] Fax: [phone]

RECEIVED
The attached form is submitted to insure that you have an opportuty to comment 1ti
on the proposal. The work is depicted on the attached drawings. If you have nGFAjkts U
the proposal, please return the form with your response within ten (10) days to this office.
If you do have objections to the project, please forward your comments to:
Stephen Lane
NC Division of Coastal Management
400 Commerce Ave
Morehead City, NC 28557
No response within ten (10) days will be construed to mean you have no objections.
Thank you for your cooperation.
Sincerely,
Jerry Jennings, P.E.
Division Engineer, Division One
Clay Willis
Environmental Officer, Division One
113 Airport Dr., Suite 100, Edenton, NC 27932 — Phone: [phone] Fax: [phone]

ECEd63FD
Ur 2 2010
ADJACENT RIPARIAN LANDOWNER STATEME100POOdritt►mm
(Hyde: Bridge # 13 on SR 1110 (Nebraska Rd)
I, , am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the pipe
replacement on SR 1110 (Nebraska Rd). I am further aware that this work will occur in
an AEC and therefore will require authorization from the Division of Coastal
Management in accordance with the Coastal Area Management Act (LAMA).
I have no objection to the project as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
are attached.
I have objections to the project as presently proposed and my comments
Signature of Adjacent Landowner
Date:

12/23/2010 08:10 DIVISION 1 EDENTON � 912522473330 NO.046 902
rUC,jf-!
2`: Z•' _� IV 3 D:JJS!ON 1 EFiENIUH i
ADJACENT&PAR.IAN LANQ0W1 ER s-rA►TCMF.lVT
(1-lyde: 8-ridge # 13 on SR 1110 (\ebm5ka Rd)
], "_ �•'t � � -1 am an adjacent riparian propeny oivaer and am
aware of the Nort i C-ai,olina Departrncln[ oiTrsin.5p�,.tutiv:i's plays for the pipe
rcpi�e�ment cn Sly ] t lU (Nebraska Rd). 1 aan Iurtheta.waratllat ti'ris work will occui in
an AEC and tlll�l'einre Will rraqu.ire ar,thtriratiurs from the Division of
Manaf er tt m in xxz)r&nce with the Coivni Aye4 Mi agameni Act tCAMA),
_ 1 have, no ob,i cxtion to the project as presently proposed and hcrely waive:
chow right of objection as provided in General Stat►,te ] 113-229.
t have objections to tine prgiect as preserstly proposEd as d my comments
�'-, are attae]1ed.
-7 r .
Signature of Adjae'at c]awner
Hate;

12/23/2010 08:10 DIVISION 1 EDENTON 3 912522473330 NO.046 901
NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
DIVISION ONE OFFICE
113 AIRPORT DR,
EDENTON, NORTH CAROLINA
TELEPHONE [phone]
FAX [phone]
DATE: t 2/23r10
FAX COVER SHEET
TIME:
8:06 AM
TO:
_Stephen ,cane
PHONE:
252-808.2808
FROW
It an Shook
PRONE:
252-482-7977
NUMBER OF PAGES INCLUDING COVER SHEET:
MESSAGE
2
Stephen,
Here is the adjacent landowner notice from Earl Pugh, Jr, for his right of way Adjacent to Hyde # 13 on
SR 1110 Nebraska Rd. I will also email this to you aq a pdf.
Thanks,
R an

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Lamar Spencer
6491 NC 94
Fairfield, NC 27826
A. Signature
❑ Agent
X �'tii? y®° ❑ Addressee
B. Received by (Printed Name) C. Rate of Delivery
iI
D. Is delivery address different from item 1? 0 YeS
If YES, enter delivery address below: ❑ No
3. Service Type
Certified Mail ❑ Express Mail
Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. ArticieNumber 7009 2820 0003 3738 2855
(rransfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Rhoda J. Midyette
618 Lowe Drive
FT. Leavenworth, KS 66027
A. Signature
1D2595-02-M-1540
X ❑ Agent
1 ❑ Addressee
B. Received by (Printed Namaj C. I ate of D livery
D. Is delivery address diffe0int from item 1? Q Yes
If YES, enter delivery a&l'ress below: No
3. Service Type
ACertified Mail 0 Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7009 2820 0003 3738 2862
(Transfer from service Iabel)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

■ Complete items 11 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
E.T. Sawyer
p.p. Box 275
Pantego, NC 27860
A. Signature
p Agent
X -.Z �
�� ��
Addressee
/ Pd
B. Received by (
d Nam 1) C. Date of Delivery
�—1
`\J
D. Is delivery add
different from item 1?
❑ Yes
[I No
If YES, enter delivery address below:
3. Service Type Express Mail
Certified Mail ❑ FxP
Return for Merchandise
Registered ❑ Retu
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? Extra Fee) ❑ Yes
2, Article Number 7 0 0 9 2 8 2 0
0003 3738 2886
(Transfer from service label) _ 102595-02-M-1540
PS Form 3811, February 2004
Domestic Return Receipt
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
James Midyette, Jr.
618 Lowe Drive FT. Leavenworth, KS 66027
2. Article Number
(Transfer from service label)
PS Form 3811, February 2004
A Signature
❑ Agent
�
O Addressee
V C. Date of Delivery
B. Received by Prinfed Name) / 1 ) / O
D. Is delivery address different from item 1?
❑ Yes
❑ No
If YES, enter delivery address below:
3. Service Type Mail
Certified Mail ❑ Express
Registered ❑ Return RecelPt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
Cl Yes
8 2879
? 0 0 9 2 8 2 0 0003 373t o25s5-a2-M-1 s4o
Domestic Return Receipt