54625_NC DOT_20090928

_
WCAMA 4 LJ DREDGE & FILL J �;
GENERAL PERMIT Previous permit# —
DNew ❑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
x
f❑Rules attached.
Applicant Name ` Project Location: County
Address Street Address/ State Road/ Lot #(s)
City i. State " ZIP
Phone # ( ) s /' Fax # ( )
Authorized Agent/11
°`SJ'`
Affected ❑ CW aEW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Subdivision
City -},,=Y7j�1��.. f (v ZIP
Phone # ( ) River Basin
F
Adj. Wtr. Body ni`� ' ` £ (natItman /unkn)
Closest Maj. Wtr. Body A
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
a : (Scale:' ,r )
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel —
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other r
'j
i
1
c�
f
'
Ok
1
<
i
_
I_
—i.
.......
.... —
TE
Shoreline Length
i r I
SAV: not sure yes no
Sandbags: not sure yes io I j
Moratorium: n/a yeso�
Photos: yes.no
Waiver d: a ver Attache yes rio':
T,• Se
A buildingpermit may be required b : ❑
P Y 9 Y
Notes/ Special Conditions
note n back regarding River Basin rules.
o b g g
i
I
I
Agent or Applicant Printed Name
Signature Please read compliance statement onrbta[ck of permit"
Application Fee(s) Check #
Permit Officer's Signature
c�
Issuing Date Expiration Date
Local Planning Jurisdiction 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, certifythat 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/ I-888-4RCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above +
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
Fax:[phone]
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

r
q� / -N /
°
dCAMA / B'DREDGE & FILL
�.
54625
GfiENERLAL PERMIT
Previous permit#
Siflew ❑Modification ElComplete Reissue EJPartial Reissue
Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources .0"-
O I -7oO
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
r n�
Applicant Name /
elules attached.
Project Location: County J ei4c.�
Address lay .01v%1Id n 0 , 1yz
Street Address/ State Road/ Lot #(s) sW 16 IS
'
City W I �v�n1r\5'+h StateC ZIP (
a^ I"/n'X, -00
u
Phone # (�1 0) j� Z l Fax # ( )
Sub ivisd ion
Authorized Agent / "man ffe.-A
City
��'`�f� "� C' ZIP ;/� y3
❑ CW iv€W Er TA C ES ❑ PTS
Affected
Phone # ( ) River Basin 6,r L
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
Adj. Wtr. Body II C -e e K
at /man /unkn)
❑ PWS: ❑FC:
�l II li meet
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Closest Maj. Wtr. Body
Type of Project/ Activity C.�.I.rfry c+ -71" X S-C , c-U 1yc-Y- + 6 p' L'1vu (Scale: NIA )
Pier (dock) length
Platform(s)
Finger piers) _
Groin length
number - -
Bulkhead/ Riprap length
avgdistance offshore ma - ) t / �I/ A S I I p�
max distance offshore U V 111
Basin, channel — -�
cubic yards
Boat ramp f (J1 rh C 01-,f� 0 i CAte- i Y' +0' pe.r WN
Boathouse/ Boatlift - — - - ----- - - - - — -----r-- ---.
-- ------ --------------
Beach Bulldozing
Other %� X �a CN Vr.e1 I
Shoreline Length i
{
SAV: not sure yes -.--_-
Sandbags: not sure yes
Moratorium: n/a yes
Photos: no 1--.
Waiver Attached: yes ® - - - -
A building permit may be required by:
by: Tv✓A 6f ..T �17a'�dt See note on back regarding River Basin rules.
Notes/ Special Conditions
�+' "I VJ� %�� �c7 J'k fl �c 2 �j• la ✓ /�o /'" G / c k �`GpI-'/
Ct✓t✓`�J �"u9 y�zl c.,/ �V r/A/r ?�vi'/on G' JG�lr1e.. t��✓�".� f �� iM�jcYw.1[
I �'-\ R C C1 fa(Q N L'— L-✓f �f 3 'tti/'W c�% �Y Cx, }'" / f /L.t l fJ"` mil% �Lt r f^� c l N _ y✓< �• , i,
Agent or Applicant Printed Name
Permit0 cer's Signature
17--fir-01
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Issuing Date Expiration Date
Lo al Planning Jurisdiction Rover File Name

A" -VA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
September 29, 2009
NC DOT
124 Division Drive
Wilmington NC 28401
Dear Mr. Herndon:
Attached is General Permit #54625 C to construct a 72"x50' culvert to replace an existing
36"x60' culvert located at SR 1618 approx. 300' southeast of intersection with Center Drive in
Hampstead, NC.
In order to validate this permit, please sign the permit as indicated_ Retain the white copy for
your files and 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 1 Affirmative Action Employer — 501/6 Recycled 110°/k Post Consumer Paper

STATE OF NORTH CAROUNA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GovERNOR
MEMO TO:
FROM:
SUBJECT:
Work Order Number:
TIP Number:
Category:
EUGENE A. CONTI, JR.
SECRETARY
September 24, 2009
Stephen Lane, Field Representative
North Carolina Division of Coastal Management
Mason Herndon, Division 3 Environmental Officer
North Carolina Department of Transportation
CAMA General Permit Application for pipe replacement on SR
1618 (Hughes Rd.), Hampstead, Pender County
3B.207111
01 KI
$400.00 fee
cc: Brad Shaver, US Army Corps of Engineers
124 Division Drive, Wilmington, NC 28401
PHONE: [phone] FAX: [phone]

scowl
APPLICATION for
Major Development Permit
Gast revilsed 12127106)
North Carolina DIVISION OF COASTAL MANAGEMENT
1. Primary Applicant/ Landowner Information
Business Name
N.0 Department Of Transportation
Project Name (if applicable)
Hughes Rd (SR 1618)
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)
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
Phone No. 1
910 - 251 -
5724 ext.
Phone No. 2
- ext.
FAX No.
910 251 5727
Contractor #
Street Address (if different from above)
City
Sta
a
ZIP
Email
<Form continues on back>

Form 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 1618
Subdivision Name
City
State
Zip
N/A
N/A
N/A
N/A -
Phone No.
Lot No.(s) (if many, attach additional page with list)
N/A - - ext.
N/A, ,
a. In which NC river basin is the project located?
b. Name of body of water nearest to proposed project
Cape Fear
Mill Creek
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
Mill 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.)
N/A
N/A
c.
Size of individual lot(s)
d. Approximate elevation of tract above NHW (normal high water) or
N/A, I I
NWL (normal water level)
(If many lot sizes, please attach additional page with a list)
4.7 ®NHW or ❑NWL
e.
Vegetation on tract
N/A
f.
Man-made features and uses now on tract
NCDOT 2 lane paved secondary roadway
g.
Identify and describe the existing land uses adiacent to the proposed project site.
residents/vacant wooded lots
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)
252-808-2808 , 1-888-4RCOAST .. www.nccoastaimanagement.net

Form, DCM MP-1 (Page 3 of 5)
APPLICATION for
Major Development Permit
existing wastewater treatment
N/A
o. Describe existing drinking water supply source.
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/Government
❑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
d. List all development activities you propose.
NIA
e. Are the proposed activities maintenance of an existing project, new work, or both?
Maintenance of existing
f. What is the approximate total disturbed land area resulting from the proposed project?
1900 ®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.
Removed failed 36" x 60 ft CMP and replace with a 72" x 50 ft CMP with headwalls
on both ends. Rip rap will be placed in
the blowhole on the outlet end of the pipe to prevent scour and undermining.
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.
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.
252-808-2808 .. 1-888-4RCOAST .. www.nccoastatmanagement.not

Form 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 See attached sheet
Phone No.
Address
Name
Phone No.
Address
Name
Phone No.
Address
g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, permittee, and issuing dates.
CAMA GP 1100 _ 2/9/09 NCDOT bank stabilization
USACE Nationwide 13 2/6/09 NCDOT bank stabilization
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 _9/11/09
Print Name Mason Herndon
Signature
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
252-808-2808 . 1-888-4RCOAST .. www.nccoastaimanagement.net

Form DCM MP-5
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.
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)
g• Length of proposed bridge:
i. Will the proposed bridge affect existing water Flow? ❑Yes ❑No
If yes, explain:
k. Navigation clearance underneath proposed bridge:
m. Will the proposed bridge cross wetlands containing no navigable
waters? []Yes ❑No
If yes, 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)
h• Width of proposed bridge:
j. Will the proposed bridge affect navigation by reducing or
increasing the existing navigable opening? []Yes []No
If yes, explain:
I. Have you contacted the U.S. Coast Guard concerning their
approval? ❑Yes []No
If yes, explain:
n. Height of proposed bridge above wetlands
2. CULVERTS ❑This section not applicable
a• Number of culverts proposed: 1 b. Water body in which the culvert is to be placed:
Mill Creek
< Form continues on back>
c. Type of culvert (construction material):
corrugated aluminum
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimanaoement.net revised: 10/26106

n.:aaa-i4 DCFA MP-2(Excavation and Dirt. Pale 2 of r.=)
3. SHORELINE STABILIZATION ®This section not applicable
(if development is a wood groin, use MP-4 — Structures)
a. Type of shoreline stabilization: b. Length:
❑Bulkhead ❑Riprap ❑Breakwater/Sill ❑Other: Width:
c. Average distance waterward of NHW or NWL: d. Maximum distance waterward of NHW or NWL:
e. Type of stabilization material:
g. Number of square feet of fill to be placed below water level.
Bulkhead backfill Riprap
Breakwater/Sill Other
i. Source of fill material.
f. (i) Has there been shoreline erosion during preceding 12
months?
❑Yes ❑No ❑NA
(ii) If yes, state amount of erosion and source of erosion amount
information.
h. Type of fill material.
4. OTHER FILL ACTIVITIES El This section not applicable
(Excluding Shoreline Stabilization)
a th Will fill material be brouaht 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 16.3 cu yds
(iii) Dimensions of fill area 22 L x 5 W x 4 D
(iv) Purpose of fill
Backfill blowhole w/rip rap to prevent undermining of pipe.
5. GENERAL
a. How will excavated or fill material be kept on site and erosion
controlled?
N/A
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.
submerged aquatic vegetation (5AV), shell bottom (5rs), 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:
Fill is in open water
b. What type of construction equipment will be used (e.g., dragline,
backhoe, or hydraulic dredge)?
backhoe
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.
9/10/09 Mason Herndon
Date
Hughes Rd. (SR 1618), Pender County
Project Name
Applicant Name
Applicant Signature

Form DCM MP-2
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
Canal
Boat Basin
Boat Ramp
Rock Groin
Rock
(excluding
(NLW or
Breakwater
shoreline
NWL)
stabilization
Length
N/A
N/A
N/A
N/A
N/A
N/A
22
Width
5
Avg. Existing
NA
NA
7
Depth
Final Project
NA
NA
3
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
d.
High -ground excavation in cubic yards.
(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
❑WL ❑None
(ii) Describe the purpose of the excavation in these areas:
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?
d.
(i) Will a disposal area be available for future maintenance?
❑Yes ❑No ❑NA
❑Yes [-]No ❑NA
(ii) If no, attach a letter granting permission from the owner.
(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 ❑NA
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
❑WL ❑None
(ii) Describe the purpose of disposal in these areas:

NOTIFICATION OF ADJACENT PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property
affirm that I have provided notification to each of them concerning my intent to complete these
repairs/improvements and to apply for a CAMA permit.
(Name) (Address)
(1) Thomas Johnnie Gilbert, Jr. 101 Atlantic Ave., Kure Beach, NC 28449
(2) Washington Acres, Inc. PO Box 441, Hampstead, NC 28443
(3) Greystone of Pender, LLC PO Box 1069, Hampstead, NC 28443
(4) Tobish William, et.al. 625 Hadley Ct., Wilmington, NC 28405
(5)
(6)
(7)
(8)

Form 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)
f. Length of proposed culvert: 50 ft
h. Height of the top of the proposed culvert above the NHW or NWL.
2.5 ft
j. Will the proposed culvert affect navigation by reducing or
increasing the existing navigable opening? ❑Yes ®No
If yes, explain:
e. (i) Will proposed culvert replace an existing culvert?
®Yes []No
If yes,
(ii) Length of existing culvert(s): 60 ft
(iii) Width of existing culvert(s): 36"
(iv) Height of the top of the existing culvert above the NHW or
NWL: 0
(v) Will all, or a part of, the existing culvert be removed?
(Explain) Entire culvert will be removed & replaced.
9• Width of proposed culvert: 72"
i. Depth of culvert to be buried below existing bottom contour.
1ft
k. Will the proposed culvert affect existing water flow?
®Yes ❑No
If yes, explain: less restrictive due to larger single
opening
3. EXCAVATION and FILL ❑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, aqua?ic 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: 50 ft feet affected.
(iii) Avg. width of area to be excavated: 10 ft ❑CW ❑SAV ❑SB
(iv) Avg. depth of area to be excavated: 6 ft OWL ®None
(v) Amount of material to be excavated in cubic yards: 112
(ii) Describe the purpose of the excavation in these areas:
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: 50
(iii) Avg. width of area to be excavated: 20
(iv) Avg. depth of area to be excavated: 4
(v) Amount of material to be excavated in cubic yards: 148
252-808-2808 :: 1-888-4RCOASi :: vvwvv nccoastaimanagec»ent.net revised: 10/26106

Form 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.)
(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: 50
(iii) Avg. width of area to be filled: 10
(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:
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 ❑SAV ❑SB
❑WL ®None
(ii) Describe the purpose of the excavation in these areas:
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? d. How will excavated or fill material be kept on site and erosion
❑Yes ®No controlled?
If yes, complete Form DCM-MP-2. Strict enforcement of NCDOT's sedimentation & erosion
control BMP's and policy will be enforced.
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimanauement.net revised:10/26106

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
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.
9/11 /09
Date
PC 1618 BM Pipe Replacement
Project Name
Mason Herndon
Applicant Name
.��-
Applicant Signature
f. 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.
252-808-2808 :: 1-888-4RCORST :: www.nccoastaimanaciement.net revised: 10/26/06

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PENDER COUNTY
HUGHES RD (SR 1618)
Thomas Johnnie Gilbert Jr.
345 Twin Oaks Or.
Hampstead.NC 28443
Washington Acres Inc.
PO Box 441
Hampstead.NC 28443
Rip rep to stabilize blowhole on outlet
MHW-- ------ — — — -- —
Streambed
SCALE 20:1
sr 161 8hughes rd pr.dgn 9/1 1 /2009 1 1 :01 :17 AM
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Sept 9, 2009
Groystone of Pender LLC
PO Box 1069
Hampstead.NC 28443
Replace 36' x 60 ft CMP
th 72' x 50 ft CMP w/headwalls
ope Tobish William et al
625 Hadley Ct.
Wilmington. NC 28405
R / W SCALE 20:1
SCALE 10:1

Lane, Stephen
From: Herndon, Mason
Sent: Friday, September 25, 2009 10:03 AM
To: Lane, Stephen
Subject: Hughes Rd
Attachments: Hughes Rd Adj PO.pdf
Stephen
Attached is the adj property owner receipts for Hughes Rd. William Tobish came back
undeliverable with no forwarding address. Thanks for your help. MH
Mason Herndon
NC DOT Division 3
Environmental Supervisor
910-251-5724
Email corre5spondexce to arid front his sendler 's subjecl to the N.C-. Public/ Records Law and rrmy be discclo5ed to third partiles.
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■ Print your name and address on the reverse
so that we can return the card to you.
s Attach this card to the back of the mailpfece,
or on the front If space permits.
1. Article Addressed to:
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B. Received by (Printed Neme) C. Date of Delivery
D. Is delivery address dfiterent from item 19 ❑ Yes
If YES, enter delivery address below: EJ No
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2. Article Number
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PS Form 3811, February 2004
❑ Registered ;9 Return Receipt for Merchandise
❑ Insured Mail 0 C.O.D.
4. Restricted DeINery? (Extra Fee) Cl Yes
7008 1140 0002 3408 3843
Domestic Return Receipt
■ Complete items 1, 2, and 3. A)so 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.
III Attach this card to the back of the mailpfece,
or on the front If space permits.
1. Article Addressed to:
34S Twi), D alCs Dr.
PO-4-i pa�-ea , N C
10258502.M-1540
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B. Received by (PrirtW N e r� C. Date
D. fs delivery address different fro 0 Yes
If YES, enter delivery address belo ❑ No c,
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❑ Insured Mall ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7008 1140 0002 3408 3829
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USPS - Track & Confirm
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49UNITEDSTATES
- POST4L SERVICE �.
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Label/Receipt Number: 7008 1140 0002 3408 3836
Service(s): Certified Mail"
Status: Notice Left
We attempted to deliver your item at 9:26 AM on September 25, 2009 in
HAMPSTEAD, NC 28443 and a notice was left. You may pick up the item
at the Post Office indicated on the notice, go to www_.usDs.com/rede_livery,
or call 800-ASK-USPS to arrange for redelivery. If this item is unclaimed
after 30 days then it will be returned to the sender. Information, if
available, is updated periodically throughout the day. Please check again
later.
Detailed Results:
• Notice Left, September 25, 2009, 9:26 am, HAMPSTEAD, INC 28443
• Forwarded, September 19, 2009, 10:29 am, HAMPSTEAD, NC
• Forwarded, September 15, 2009, 9:37 am, HAMPSTEAD, INC
• Arrival at Unit, September 15, 2009, 9:25 am, HAMPSTEAD, INC 28443
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Label/Receipt Number: 7008 1140 0002 3408 3843
Service(s): Certified Mail"
Status: Moved, Left no Address
Your item was returned to the sender on September 16, 2009 because
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Detailed Results:
• Moved, Left no Address, September 16, 2009, 1:27 pm, WILMINGTON, NC
• Undeliverable as Addressed, September 15, 2009, 10:27 am, WILMINGTON, NC 28405
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Label/Receipt Number: 7008 1140 0002 3408 3805
Service(s): Certified MaiIT`"
Status: Notice Left
We attempted to deliver your item at 2:52 PM on September 15, 2009 in
HAMPSTEAD, NC 28443 and a notice was left. You may pick up the item
at the Post Office indicated on the notice, go to www_usps_com/redelivery,
or call 800-ASK-USPS to arrange for redelivery. If this item is unclaimed
after 30 days then it will be returned to the sender. Information, if
available, is updated periodically throughout the day. Please check again
later.
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Enter Label/Receipt Number.
Detailed Results:
• Notice Left, September 15, 2009, 2:52 pm, HAMPSTEAD, NC 28443
• Arrival at Unit, September 15, 2009, 9:25 am, HAMPSTEAD, NC 28443
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Get current event information or updates for your item sent to you or others by email.
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