55243_NC DOT_20100615

•CAMA / ❑ DREDGE & FILL
�lIt! 15
GGENERAL PERMIT
'
Previous permit #�
J —�
❑New ❑Modification []Complete Reissue
❑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
O Rules attached.
Applicant Name
Project Location: County
Addresstj
Street Address/ State Road/ Lot #(s)
r City !ay { ra ``J'. J,r, State `.. ZIP ..
Phone # O Fax # (�)
Subdivision
Authorized Agentj
City # 1' ;' s C ZIPAffected
❑ CW ❑ EW RPTA [,ES ❑ PTS
Phone # ( ) River Basin Cr~' e
AEC(s): ❑ CEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body �' r C ✓ r �" that''/man /unkn)
❑ PWS: ❑FC:
1
ORW: yes / no PNA yes / no Crit.Hab.
Closest Maj. Wtr. Body
yes / no
Type of Project/ Activity
(Scale: j:V ,
Pier (dock) ler^�k
Platform(s)_
Finger pier(s)_
Groin length
number
Bulkhead/ Rip
avg distance cnuiwic
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length•
r --
SAV: not sure yes no
Sandbags: not sure yes (no) —
i
Moratorium: n/a ye3, no
�r _
Photos: yes no
Waiver Attached: yes no —
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 Expiration Date
Local Planning Jurisdiction Rover File Name
)I

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 comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office Morehead City Headquarters
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-2808/ 1-888-4RCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
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

Y'CAMA / [Y-611REDGE & FILL
N? 55243
GENERAL PERMIT
Previous permit #
YNew ❑Modification ❑Complete Reissue
❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources 3 , J
and the Coastal Resources Commission in an area of environmental
concern pursuant to 15A NCAC
Applicant Name N� 1r
[?Rules attached.
Project Location: County re-' A'1-
Address �� `� l
Street Address/ State Road/ Lot #(s) -s g 1 's. C t i
City �f�ml:��•�� StateZIP
U}r�,-.x. -�o0 .SL- o S,� %✓t �,S
Phone # (9 11,) Fax # ()
Subdivision --
Authorized Agent ' `� y�
City 14•r frfz�c•f N Z- ZIP 3 r �y
CHEW �W E-4TA [�?IS ❑ PTS
Phone # ( ) 7 River Basin C'y c � r
Affected
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body )Vf x Ly 6'Z. ¢ k b>a>/ man /unkn)
❑ PWS: ❑ FC:
�✓ i✓
ORW: yes / no PNA (fie /no Crit.Hab.
yes / no Closest Maj. Wtr. Body
Type of Project/ Activity Gil .r't/u( c &y 17 I / + X 9 / 0 `+ X S j C a %✓ '�" �4 j,2f+�a c z
��e. -l'v✓„ ;Jfi�J //7 X -79X 1( iIve.-'�, Scale:
s (
Pier (cinck) length
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other 11 ` 1% a A
C iA ye'r j
r
Shoreline Length '
_1-- r� —
SAV: not sure yes nd i
- -
Sandbags: not sure yes no j
Moratorium: n/a yes'.• no
-t
Photos: es no
Waiver Attached: yes �L� _ - — -- -- ------------- - ---
PCVmif
/',
A building permit may be required by: /'t�^" / re, d`j� p ``tto fv ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions C:� ✓� % ^ `� _i /� ' 1 �``� 1 2/"7�,y ��" r,rc �oW j�1,/'^-I J fry ��r �� �`
/J«�r #&
�:- �a��J_ 3� N_ ,'.,- i.✓.,
�.�✓
�/�;H I.^c r/�oc✓L.Y L„ziWZ2r %'Z�j. /.r— /7�n3�,rt 31 �� ^y yexr; +t1�o r�., !� �1.�.'�✓cl fr��� �C%h�
v A 4 ri J' . f', + n W I r k JV O A r, U :. X f i i^,. l✓ � s d u '!-r � '!<+-�.+.�-�l •'tc , ^ 1 ' I� A—J :- � .. �a �".i io c
Agent or Applicant Printed Name
Permit Officer's Signature
4--1s=10
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Issuing Date Expiration Date
Local Plan ningJurisdiction Rover File Name

WA
A: •
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
June 16, 2010
Mason Herndon
NC DOT
124 Division Drive
Wilmington, NC 28401
Dear Mr. Herndon:
Attached is General Permit #55243C
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.net
An Equal Opportunity \ Affirmative Action Employer - 50% Recycled \ 10% Post Consumer Paper

f
x wSign of Ccmstal10. g Habitat im—pact -�.+ a zx r!
Applicant:' N C 00r
Date: 6-- 9- f a
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
tem im acts)
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)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Dredge (" Fill [" Both Other ❑
L.0W t,f
Dredge [� Fill [� Both [� Other ❑
?ice
?�
t •✓yU��
Dredge [� Fill [Er Both [Other El)L
B U
7
{;
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
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.._......... _.._._ ._.............. . ............. �t

ee`SfNEq
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
MEMO TO:
FROM:
SUBJECT:
Work Order Number:
TIP Number:
Category:
May 24, 2010
Stephen Lane, Field Representative
North Carolina Division of Coastal Management
Mason Herndon, Division 3 Environmental Officer
North Carolina Department of Transportation
RE^C':I'll [4-)
MAY 2 6 z010
Morehead City DCM
EUGENE A. CONTI, JR.
SECRETARY
V) �
CAMA General Permit Application for pipe replacement on SR
1566 (Mallard Bay Rd.), Pender County
3B.207111
N/A
$400.00 fee
cc: Brad Shaver, US Army Corps of Engineers
124 Division Drive, Wilmington, NC 28401
PHONE: [phone] FAX: [phone]

APPLICATION for RECEIVE&
Major Development Permit l'qY 2 6 20
10
(last revised 12/27/06) 6
North Carolina DIVISION OF`COA5? l MANAGEMENT
1. Primary Applicant/ Landowner Information
Business Name
N.0 Department Of Transportation
Project Name (if applicable)
P-210
Applicant 1: First Name
H
MI
Allen
Last Name
Pope
Applicant 2: First Name
MI
Last Name
If additional applicants, please attach an additional page(s) with names listed.
Mailing Address
123 Division Dr.
PO Box
City
Wilmington
State
NC
ZIP
28401
Country
United States
Phone No.
910 - 251 -
5724 ext.
FAX No.
910 - 251 - 5727
Street Address (if different from above)
I City
State
ZIP
Email
2. Agent/Contractor Information
Business Name
N.0 Department Of Transportation
Agent/ Contractor 1: First Name
Mason
MI
Last Name
Herndon
Agent/ Contractor 2: First Name
MI
Last Name
Mailing Address
123 Division Dr
PO Box
City
Wilmington
State
NC
ZIP
28401 -T
Phone No. 1
910 - 251 - 5724 ext.
Phone No. 2
ext.
FAX No.
910 251 5727
Contractor #
Street Address (if different from above)
City
State
ZIP
Email
<Form continues on back>
252-808-2808 . 1-888-4RCOAST .. www.nccoastaImanagement.net

Farm DCM MP-1 (Page 2 of 5)
APPLICATION for
Major Development Permit
3. Project Location
County (can be multiple)
Street Address
State Rd. #
Pender
N/A
SR 1566 ,P
Subdivision Name
City
State
Zip
N/A
NIA
N/A
N/A - 4t
Phone No.
Lot No.(s) (if many, attach additional page with list) o
N/A - - ext.
N/A, q
a. In which NC river basin is the project located?
b. Name of body of water nearest to proposed project <`rC"
Cape Fear River
Nixon Creek 4'
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
AIWW
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.)
N/A
N/A
c. Size of individual lot(s)
d. Approximate elevation of tract above NHW (normal high water) or
N/A, I ,
NWL (normal water level)
(If many lot sizes, please attach additional page with a list)
5.3 ®NHW or ❑NWL
e. Vegetation on tract
N/A
f. Man-made features and uses now on tract
NCDOT
g. Identify and describe the existing land uses adjacent to the proposed project site.
residents/coastal wetlands
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 SNA
j. Is the proposed activity part of an urban waterfront redevelopment proposal? [-]Yes ®No
k. Has a 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 ZNA
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)
252-808-2808 .. 1-888-4RCOAST .. www.nccoastalmanagement.net

Form DCM MP-1 (Page 3 of 5)
APPLICATION for
Major Development Permit
n. Describe existing wastewater treatment facilities.
N/A
o. Describe existing drinking water supply source. -0 `vI
N/A _ � .
p. Describe existing storm water management or treatment systems.
N/A
5. Activities and Impacts
a.
Will the project be for commercial, public, or private use?
❑Commercial ®Public/Govemment
❑Private/Community
b.
Give a brief description of purpose, use, and daily operations of the project when complete.
standard secondary road infrastructure
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.
NCDOT standard roadway equipment, backhoe, trucks, crane
d.
List all development activities you propose.
Remove 2 existing 117" x 79" x 52 ft corrugated metal pipes and headwall. Install one line 14' 11" x 9' 10" x 58.5 ft aluminum
structural plate arch pipe with headwalls.
e.
Are the proposed activities maintenance of an existing project, new work, or both?
Replacement of existing
f.
What is the approximate total disturbed land area resulting from the proposed project?
3200 SSq.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.
Fill is required to rebuild and widen the shoulders.
i.
Will wastewater or stormwater be discharged into a wetland?
0Yes ®No EINA
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.
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 distinguish
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.
2 5 2 - 8 0 8 - 2 8 0 8 .. 1-888-4RCQAST .. www.nccoastaImanagement.net

Porm DCM MP-1 (Page 4 of 5)
APPLICATION for
Major Development Permit
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 Long 2B LLC �f FC��
Phone No. '�10� 9�2 4`FO
Address 5101 Dunlea Ct., Suite 204A. Wilmington, NC 28405
r�
OC,
Name Kathleen Casieri
Phone No.
Address 1249 Nightingale Ct. Leland, NC 28451
Name Stanley W. West
Phone No.
Address 1335 Midland Rd., Southern Pines, NC 28387
g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, permittee, and issuing dates.
Unknown
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.
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 _5/19/10
Print Name Mason Hemdon
Signature zzz .
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
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Form DCIN MP-5
BRIDGES and CULVERTS *hOl1115
2��
®ap
00
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of ihe,Joint
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/Community
c. Type of bridge (construction material):
e. (i) Will proposed bridge 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)
d. Water depth at the proposed crossing at NLW or NWL:
f. (i) Will proposed bridge replace an existing culvert? ❑Yes []No
If yes,
(ii) Length of existing culvert:
(iii) Width of existing culvert:
(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. Length of proposed bridge: h. Width of proposed bridge:
I. Will the proposed bridge affect existing water flow? ❑Yes []No j. Will the proposed bridge affect navigation by reducing or
If yes, explain: increasing the existing navigable opening? ❑Yes []No
If yes, explain:
k. Navigation clearance underneath proposed bridge:
1. Have you contacted the U.S. Coast Guard concerning their
approval? ❑Yes ❑No
If yes, explain:
m. Will the proposed bridge cross wetlands containing no navigable n. Height of proposed bridge above wetlands:
waters? ❑Yes ❑No
If yes, explain:
12. CULVERTS ❑This section not applicable
a. Number of culverts proposed: 1 b. Water body in which the culvert is to be placed:
Nixon Creek
< Form continues on back>
c. Type of culvert (construction material):
corrugated aluminum
252-808-2808 :: 1-888-4.RCOAST :: www.nccoastaimanagement.net revised: 10/26/06

FcirM DCM MP-5 (Bridges and Culverts, Page 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)
e. (i) Will proposed culvert replace an existing culvert? � Aeo,
�Ye�/❑No F2
If yes, ' 0-
(I!) Length of existing culvert(s): 52 ft ®0
(iii) Width of existing culvert(s): 2 (ci) 117" x 79" Cad
(iv) Height of the top of the existing culvert above the NHW
NWL: 1.5 ft
Length of proposed culvert: 58.5 ft 9•
Height of the top of the proposed culvert above the NHW or NWL. I.
3.7 ft
Will the proposed culvert affect navigation by reducing or k.
increasing the existing navigable opening? ®Yes [:]No
If yes, explain: proposed taller and wider single barrel
will increase navigation opening.
(v) Will all, or a part of, the existing culvert be removed?
(Explain) Entire culvert will be removed & replaced.
Width of proposed culvert: 14' 11" x 9' 10"
Depth of culvert to be buried below existing bottom contour.
1ft
Will the proposed culvert affect existing water flow?
®Yes ❑No
If yes, explain: less restrictive due to larger single
opening
3. EXCAVATION and FILL El This section not applicable
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: 60 feet affected.
(iii) Avg. width of area to be excavated: 21 ft ®CW 120 ❑SAV ❑SB
(iv) Avg. depth of area to be excavated: 2 ft OWL ❑None
(v) Amount of material to be excavated in cubic yards: 93
(ii) Describe the purpose of the excavation in these areas:
Excavation for the headwalls on either end of the pipe
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: 55
(iii) Avg. width of area to be excavated: 40
(iv) Avg. depth of area to be excavated: 6
(v) Amount of material to be excavated in cubic yards: 490
252-808-2808 :: 1-888.4RCOAST :: www.nccoastalmanag�qnlent.net revised: 10126/06

Fcirtn,DCM MP-5 (Bridges and Culverts, Page 3 of 4)
d. If the placement of the bridge or culvert involves any excavation, please complete the following:
(i) Location of the spoil disposal area: NCDOT yard
(ii) Dimensions of the spoil disposal area: 20 x 20
(iii) Do you claim title to the disposal area? ®Yes ❑No (If no, attach a letter granting permission from the owner.) G
(iv) Will the disposal area be available for future maintenance? ®❑F�e/
Yes No �✓p E`
(v) Does the disposal area include any coastal wetlands/marsh (CW), submerged aquatic vegetation (SAVs), other wetlands (WL), orP�',1,811 2fi
bottom (SB)?
❑CW ❑SAV OWL ❑SB ®None `a
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: 58.5
(iii) Avg. width of area to be filled: 21
(iv) Purpose of fill: bedding stone for pipe
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:
(iii) Avg. width of area to be filled:
(iv) Purpose of fill:
4. GENERAL
a. Will the proposed project require the relocation of any existing
utility lines? ®Yes ❑No
If yes, explain: temporary pole will be required to move
overhead power line.
If this portion of the proposed project has already received
approval from local authorities, please attach a copy of the
approval or certification.
(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 (SB), or other wetlands
(WL)? If any boxes are checked, provide the number of square
feet affected.
®CW 114 ❑SAV ❑SB
❑WL ®None
(ii) Describe the purpose of the excavation in these areas:
fill required to rebuild shoulder behind headwalls
b. Will the proposed project require the construction of any temporary
detour structures? ❑Yes ®No
If yes, explain:
< Form continues on back>
c. Will the proposed project require any work channels?
❑Yes ®No
If yes, complete Form DCM-MP-2.
d. How will excavated or fill material be kept on site and erosion
controlled?
Strict enforcement of NCDOT's sedimentation & erosion
control BMP's and policy will be enforced.
252-808-2808 :: 1-888-411COAST :: www.nccoastalmanagement.net revised: 10126/06

Form. DCM MP-5 (Bridges and Culverts, Page 4 of 4)
e. What type of construction equipment will be used (for example,
dragline, backhoe, or hydraulic dredge)?
backhoe, excavator, crane, tandem dump trucks
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.
5/19/10
Date
PC P210 Pipe Replacement
Project Name
Mason Herndon
Applicant Name /
Applicant Signature
�F
�1/k
0
Will wetlands be crossed in transporting equipment to projectVe?
❑Yes 0*. �a
If yes, explain steps that will be taken to avoid or minimize Q�
environmental impacts.
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimana�ement.net revised: 10/26/06

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PENDER COUNTY
MALLARD BAY RD (SR 1566)
`JCS;
Kathleen Casieri
1249 Nightingale Ct.
Leland, NC 28451
Replace 2 0117' x 79" x 52 ft CMP with
1 @ 14' 1l' x 9' 10" x 58.5 f t ASPPA
Long 2B LLC
5101 Dunlen Ct. Suite 204A
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Wilmington, NC 28405
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® coastal wetland impacts
120 sq ft
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Stanley W.West
1335 Midland Rd
Southern Pines, NC 28387
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TOPSAIL BEACH

■ 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.
Article Addressed to:
Kathleen Casien
1249 Nightingale Ct.
Leland, NC 28451
A Ni�gnature❑ Agent
X ❑ Addressee
B. Fieceivbd bet (Pr*ted:Nam6 I C. Date of Delivery
D. Is delivery address different from Rem 1? ❑ fe:
If YES, enter delivery address below: ❑ No
3. S rvice Type
Certified Mail ❑ Express Mail
❑ Registered XRetum Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7009 1410 0000 9448 1891
(Transfer from service label,
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540'

XED STATES POSTAL -SERVICE —
AIR.'
0 Sender: Please print your name, acldre'ss,
NCDOT
124 Division Dr.
Wilmington, NC 28401

■ Complete items 1, 2, and 3. Also complete A
item 4 if Restricted Delivery is desired. X
■ 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:
Stanley W. West
1335 Midland Rd.
Southern Pines, NC 28387
�J� 1111 y V ❑ Addressee
Received by (Print d Nam C. Date of Delive�
Is delivery address different from item 1? Yes
If YES, enter delivery address below: ❑ No
3. Se ice Type
Certified Mail ❑ Express Mail
❑ Registered Jli(Retum Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7009 1410 0000 9448 1907
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

UNITED STATES P08T'A�SE�2�GE�
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• Sender: Please print your name, address, and ZIP+4 in this box •
it
NCDOT
124 Division Dr.
Wilmington, NC 28401
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■ 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.
'i 1. Article Addressed to:
Randy M. Long
Long 2B LLC
5105 Dunlea Ct. Suite 204A
Wilmington, NC 28405
L7
ecelved by (Printed Vie) D e of elivery
i_ U 54110
D. Is delivery address differefit from item 1? Yes
If YES, enter delivery address below: ❑ No
3. Service Type
Certified Mail ❑ Express Mail
❑ Registered DrRetum Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7009 1410 0000 9448 1884
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

UNITED STATE�,jPQ,. Mix:;
• Sender: Please print your name, address, and ZIP+4 in this box •
NCDOT
124 Division Dr.
Wilmington, NC 28401
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RECEIVED
:JUN 0 4 2010
MOreheacs City DCM
Determination of Jurisdiction:
❑ Based on preliminary information, there appear to be waters of the US including wetlands within the above described project area.
This preliminary determination is not an appealable action under the Regulatory Program Administrative Appeal Process
( Reference 33 CFR Part 331).
® There are Navigable Waters of the United States within the above described project area subject to the permit requirements of
Section 10 of the Rivers and Harbors Act and Section 404 of the Clean Water Act. Unless there is a change in the law or our
published regulations, this determination may be relied upon for a period not to exceed five years from the date of this
notification.
® There are waters of the US and/or wetlands within the above described project area subject to the permit requirements of Section
404 of the Clean Water Act (CWA)(33 USC § 1344). Unless there is a change in the law or our published regulations, this
determination may be relied upon for a period not to exceed five years from the date of this notification.
❑ The jurisdictional areas within the above described project area have been identified under a previous action. Please reference
jurisdictional determination issued. Action ID
Basis of Jurisdictional Determination: The subiect area exhibits wetland criteria as described in the 1987 Corps Delineation
Manual and is adiacent to NixomCreek, a creek subiect to the ebb and flood of tides
Corps Regulatory Official:
Date 6/2/2010
Expiration Date 6/2/2015
Copy Furnished:
NCDENR-DCM attn: Stephen Lane 400 Commerce Drive Morehead City, NC 28557
NCDENR-DWQ attn: David Wainwright 2321 Crabtree Blvd Raleigh, NC 27604
Page 2 of 2
J

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action ID. 2010 900 County: Pender USGS Quad: Topsail
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Applicant: NC DOT — Division 3 Agent: NC DOT — Division 3
Address: attn: H. Allen Pope, P.E., Division Engineer attn: Mason Herndon, DEO
124 Division Drive 124 Division Drive
Wilmington, NC 28401 Wilmington, NC 28401
Size and location of property (water body, road name/number, town, etc.): The culvert replacement project is located
along SR 1566 (Mallard Bay Rd.) northeast of Hampstead, Pender County,
Description of projects area and activity: This verification covers the impact to 6.5 linear feet of a tidal creek (Nixon
Creek) and 120 square feet of coastal wetlands to create safer shoulders in the approach.
Applicable Law: ® Section 404 (Clean Water Act, 33 USC 1344)
® Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number:
Nationwide Permit Number: NW-3
SEE ATTACHED SPECIAL CONDITIONS AND NATIONWIDE CONDITIONS.
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the attached
conditions and your submitted application dated May 24, 2010. Any violation of the attached conditions or deviation from your
submitted plans may subject the permittee to a stop work order, a restoration order and/or appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide authorization is modified,
suspended or revoked. If, prior to the expiration date identified below, the nationwide permit authorization is reissued and/or
modified, this verification will remain valid until the expiration date identified below, provided it complies with all requirements of
the modified nationwide permit. If the nationwide permit authorization expires or is suspended, revoked, or is modified, such that the
activity would no longer comply with the terms and conditions of the nationwide permit, activities which have commenced (i.e., are
under construction) or are under contract to commence in reliance upon the nationwide permit, will remain authorized provided the
activity is completed within twelve months of the date of the nationwide permit's expiration, modification or revocation, unless
discretionary authority has been exercised on a case -by -case basis to modify, suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Quality (telephone [phone]) to determine Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal Area Management Act (CAMA),
prior to beginning work you must contact the N.C. Division of Coastal Management.
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal,
State or local approvals/permits.
If there are any questions regarding this verification, any of the conditions of the Permit, or the Corps of Engineers regulatory
program, please contact Brad Shaver at 910-251-4611.
Corps Regulatory Official f Z4 Date: 6/2/2010
Expiration Date of Verification: 3/18/2012
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we continue to do so,
please complete the attached customer Satisfaction Survey or visit http://www.saw.usace.army.mil/WETLANDS/index.html to
complete the survey online.
Page 1 of 2

Action ID Number:2010 900 County:Pender
Permittee: NCDOT-Division 3
Date Verification Issued: 6/2/2010
Project Manager: Shaver
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
WILMINGTON REGULATORY FIELD OFFICE
69 DARLINGTON AVE
WILMINGTON, NORTH CAROLINA 28403
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. If you fail to comply with this permit you are subject to permit suspension,
modification, or revocation.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
Signature of Permittee Date

SPECIAL CONDITIONS
State Project : 313.207111
Action ID 2010 900
COMPLIANCE WITH PLANS
1. All work must be performed in strict compliance with the plans attached to the NCDOT letters dated May
24, 2010, which are authorized by this permit. Any modification to the authorized permit plans must be
approved by the USACE prior to implementation.
COMPLIANCE WITH SPECIAL CONDITIONS
2. Failure to institute and carry out the details of the following special conditions, below, will result in a
directive to cease all ongoing and permitted work within waters and/or wetlands associated with the permitted
project, or such other remedies and/or fines as the District Engineer or his authorized representatives may seek.
CONSTRUCTION PLANS
3. The permittee will ensure that the construction design plans for this project do not deviate from the
authorized permit plans. Any deviation in the construction design plans will be brought to the attention of the
Corps of Engineers, Wilmington Regulatory Field Office prior to any active construction in waters or wetlands.
CONTRACTOR COMPLIANCE
4. The permittee shall require its contractors and/or agents to comply with the terms and conditions of this
permit in the construction and maintenance of this project, and shall provide each of its contractors and/or
agents associated with the construction or maintenance of this project with a copy of this permit, and any
authorized modifications. A copy of this permit including the authorized plans referenced in Special Condition
(1) and authorized modifications, including all conditions, shall be available at the project site during
construction and maintenance of this project.
ACTIVITIES NOT AUTHORIZED
5. Except as authorized by this permit or any USACE approved modification to this permit, no excavation, fill,
or mechanized land -clearing activities shall take place at any time in the construction or maintenance of this
project, within waters or wetlands, or shall any activities take place that cause the degradation of waters or
wetlands. In addition, except as specified in the plans attached to this permit, no excavation, fill or mechanized
land -clearing activities shall take place at any time in the construction or maintenance of this project, in such a
manner as to impair normal flows and circulation patterns within, into, or out of waters or wetlands or to reduce
the reach of waters or wetlands.
This permit does not authorize temporary placement or double handling of excavated or fill material or
construction equipment within waters or wetlands outside the permitted area.
BORROW AND WASTE
6. To ensure that all borrow and waste activities occur on high ground and do not result in the degradation of
adjacent wetlands and streams, except as authorized by this permit, the permittee shall require its contractors
and/or agents to identify all areas to be used to borrow material, or to dispose of dredged, fill, or waste material.
The permittee shall provide the USACE with appropriate maps indicating the locations of proposed borrow or
waste sites as soon as the permittee has that information. The permittee will coordinate with the USACE before

approving any borrow or waste sites that are within 400 feet of any streams or wetlands. All jurisdictional
wetland lines on borrow and waste sites shall be verified by the Corps of Engineers and shown on the approved
reclamation plans. The permittee shall ensure that all such areas comply with the preceding condition of this
permit, and shall require and maintain documentation of the location and characteristics of all borrow and
disposal sites associated with this project. This information will include data regarding soils, vegetation and
hydrology sufficient to clearly demonstrate compliance with the preceding condition. All information will be
available to the USACE upon request. NCDOT shall require its contractors to complete and execute
reclamation plans for each waste and borrow site and provide written documentation that the reclamation plans
have been implemented and all work is completed. This documentation will be provided to the Corps of
Engineers within 30 days of the completion of the reclamation work.
REPORTING OF VIOLATIONS
7. The permittee will report any violation of these conditions or violations of Section 404 of the Clean Water
Act or Section 10 of the Rivers and Harbors Act in writing to the Wilmington District, U. S Army Corps of
Engineers, within 24 hours of the permittee's discovery of the violation.
SEDIMENTATION AND EROSION CONTROL MEASURES
8. All fill material must be adequately stabilized at the earliest practicable date to prevent sediment from
entering into adjacent waters or wetlands. The permittee shall remove all sediment and erosion control
measures placed in wetlands or waters, and shall restore natural grades in those areas, prior to project
completion.
9. Non -Federal applicants for any NWP in a designated "Area of Environmental Concern" (AEC) in the twenty (20)
counties of Eastern North Carolina covered by the North Carolina Coastal Area Management Act (CAMA), must
also obtain the required CAMA permit. Construction activities for non -Federal projects may not commence until a
copy of the approved CAMA permit is furnished to the appropriate Wilmington District Regulatory Field Office
(Wilmington Field Office — 69 Darlington Ave, Wilmington, NC 28403).
(LA, -
Brad Shaver
_6/2/2010
Date