42663_NC DOT_20091027

r QAMA / C; DREDGE & FILL A 126 63
GENERAL PERMIT Previous permit #
CNew ElModification CComplete 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
Applicant Name
Address
City__
: _% State ZIP
Phone # ( )Z
Fax # ( )
Authorized Agent
❑ CW
F— EW 7 PTA ❑ ES ❑ P'
Affected
L— OEA
❑I HHF ❑ IH 7 UBA Is
AEC(s):
1-1 PWS:
❑ FC:
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body.__(nat /man /unkn)
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes
no
Sandbags: not sure yes
no
Moratorium: n/a yes
no
Photos: yes
no
Waiver Attached: yes
no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ( ``Please read compliance statement on back of permit
Application Fee(s) Check #
(Scale: )
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
f1
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 [)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 Environmen;:al 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 (252-946-648 [)or the Wilmington
Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Central Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
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)
Morehead City District
400 Commerce Ave
Morehead City, NC 28557
202-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico 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 06/29/05

Pasquotank County SR 1103 Esclip Rd
pipe replacement, 0.75 miles south of SR 1116
USGS Quad - Weeksville
Pasquotank River Basin
0 0.25 0.5
1 Miles
N
W E
S

+, I
ar �,
rl'
B.T. JAMES HEIRS
102 FORREST SKIPPER DR.
ELIZABETH CITY, NO 27909:Li;
1
11 IMF
11 I
WOODS EXISTING 2
�.
7
TURBIDITY CURTAIN -
MLLIAM T. CHORY, JR.
4688 BACKWOODS RD.
CHESAPEASE, VA. 23322
PLAN VIEW
DETAILED DRA WING
e` J
s F.P. 129RIgiAhl & G. ELVIN III SMALL
ia I.
�rl 283 DRY RIDGE RD.
�`� . +eZ \ • ` i zlj ELIZABETH CITY, NC 27907
72' X 60' CMP
PROPOSED RIP P
WOODS
---------------
--------i --i --i
-I--- I---II-------I---
�--------
�-----------�����---�
SYMBOLS
PROPOSED CROSS SECTION
— — - EXISTING CROSS SECTION
WILLIAM HARRIS
282 ESCLIP RD.
ELIWETH CITY, ATC. 27909
NGITE:
PIPE .INSTALLATION WILL RAVE A TOTAL OF 291.00 Sq. Pt. OF OPEN (PATER IMPACT.
y N_
RN NORTH CAROLINA DEPARTMENT OF TRANSPORTATION �°
DIVISION 1 -
- - - 113 AIRPORT 0
R. J

DETAIL SECTION —� CROSS SECTION
2 @ 117" X 79" X 60' CAAPA _ "�"
NOTE: PROPOSED 2 Q 117" X 79" X 6,0' CAAPA TO BE BURIED
1.0' MIN., BELOW EXISTING STREAM BED
NOTE:
� S Y•1s4 0Lu
BE
Ct OF PAVEMENT
PROPOSED PIPE WILL
BURIED 1.0' MIN. BELOW EXISTING
EXISTING
PROPOSED CROSS SECTION
STREAM BED
2 Q 72" X 60' CMP
— — —
- EXISTING CROSS SECTION
TER LEVEL
_
NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
PROPOSED RIP RAP--,
1
DIVISION 1
EXISTING STREAM BED
v 113 AIRPORT DR. S
EDENTON, NO 27932 [phone]
'VhY4h'3HktR14.'21.1'ikAVfXv�xxx LTJ.Slb3'Yhb.F3hh'k*xcu+ay.xvxvxy+�,.!'3St: 4"4tS'i+iMhV'Ch�334h'2R'4'il't
COUNTY:
PROPOSED PIPE BED
�N
PASQUOTANK WBB#; NIA
fi
+ DATE: 18, 2008
PROPOSED
QUAD: WEEKSVILLE SEPTEMBER
2 Q 117" X 79" X 60' CAAPA
BASIN: PASQUOTANK SHEET*: 2 OF 2
yxscxucwra..�;v�ncwc....v�mveai.•w.�.•e�:•.�:vw.,»y�..x.•a.eu.•.uv.�..+v.�uu�.v.�e:.�a,:•.�:rv�.xa:.,car.•:ee
SUBJECT: PIPE REPLACEMENT SR 1103 ESCLIP RD.
DETAIL
SECTION
— END VIEW
LAT, = 36 149876 N fi LONG. = 76.169381 W
� � x,.a.
DRAWN BY:A•L• MULDER

DCM MP4
APPLICATION for
Major Development Permit
(last revised 12/27/06)
North Carolina DIVISION OF COASTAL MANAGEMENT
9. Primary Applicant/ Landowner Information
Business Name
N.C. Department Of Transportation
Project Name (if applicable)
SR 1103 (Esclip Rd) Pipe Replacement
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>
252-808-2808 o. 1-888-4RCOAS1 vEr�nr�er.ra,crstaasta7r��r��s��ays��st.���

Form DCM MP-1 (Page 2 of 5)
APPLICATION for
Major Development Permit
3. Project Location
County (can be multiple)
Street Address
State Rd. #
Pasquotank
SR 1103 Esclip Rd
SR 1103
Subdivision Name
City
State
Zip
Elizabeth City
NC
27909 -
Phone No.
Lot No.(s) (if many, attach additional page with list)
- - ext.
I , I ,
a. In which NC river basin is the project located?
b. Name of body of water nearest to proposed project
Pasquotank
Mill Dam 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
Albemarle Sound
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.)
130'
3600
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)
2 ❑NHW or ®NWL
e.
Vegetation on tract
Various roadside grasses )including bermuda and fescue.
f.
Man-made features and uses now on tract
SR 1103 Esclip Rd
g.
Identify and describe the existing land uses adiacent to the proposed project site.
Adjacent land use is riverine swamp forest.
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? MYes ®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? MYes ❑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..BOB-2808 1-868-4RCO AST w+nrwr,r��ora��4als�sar���a ��st.ra�z

Form DCM MP-1 (Page 3 of 5)
APPLICATION for
Major Development Permit
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.
The purpose of this project is to replace the existing pipes that are structuarlly failing on SR 1103.
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.
Methods of construction will be concurrent with NCDOT Best Management Practices for the replacement of pipes. A
tracked excavator, backhoe, and dump truck will be used during construction.
U.
LIJI GII development Il GllitI VIUGJ YVU pI VF.JV SC.
Replace existing 2 @ 60' x 72" Corrugated Metal Pipes with 2 @ 60' x 117" x 79" Corrugated Aluminum Alloy Pipe Arches
with rip rap shoulders on both sides.
e.
Are the proposed activities maintenance of an existing project, new work, or both? Maintenance
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 1103.
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.
152-808-2 810 8 n 1-888-4RCOAST

Form DCM MP-1 (Page 4 of 5)
I
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 B.T. James Heirs
Phone No.
Address 102 Forrest Skipper Dr.
Elizabeth City, NC 27909
Name F.P. Markham & G. Elvin III Small
Phone No.
Address 283 Dry Ridge Rd
Elizabeth City, NC 27907
Name William T. Chory, Jr.
Phone No.
Alidress 4568 Back -,,cods Rd
Chesapeake, VA 23322
Name William Harris
Address 282 Esclip Rd
Elizabeth City, NC 27909
g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, permittee, and issuing dates.
NIA
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.
252-<bG,8 2,1�u3 1 -88•4a COAST .. vuwutiw.ncct,7avtatmanagement.net

Form DCM MP-1 (Page 5 of 5)
APPLICATION for
Major Development Permit
Date ) 0 / l0 0 D Print Name _Clay Willis, Environmental Officer
Signature O
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 1-833-4 COOS

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
Width
Avg. Existing
NA
NA
Depth
Final Project
Depth
NA
NA
1. EXCAVATION Z 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 (SIB),
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:
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 RNA
(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
(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 disposal in these areas:
(i) Does the disposal include any area in the water?
❑Yes []No ❑NA
(ii) If yes, how much water area is affected?
3. SHORELINE STABILIZATION []This section not applicable
(If development is a wood groin, use MP-4 — Structures)
vawaccastaBanagement.not rgvas d. 12i'Bcfo

. F-p 'm ae-ld 'ttsj Page 2 :af `?)
a. Type of shoreline stabilization: b. Length: 60'
❑Bulkhead ®Riprap ❑Breakwater/Sill ❑Other: Width: 3' - 5'
c. Average distance waterward of NHW or NWL: 4' d. Maximum distance waterward of NHW or NWL: 5'
e. Type of stabilization material:
Class "B" rip rap
g. Number of square feet of fill to be placed below water level
Bulkhead backfill Riprap 240
Breakwater/Sill Other
i. Source of fill material.
quarry
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.
riprap
4. OTHER FILL ACTIVITIES ®This section not applicable
(Excluding Shoreline Stabilization)
3. (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 (613), 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)?
Using NCDOT Best Management Practices for soil and erosion tracked excavator, backhoe, dumptruck
control.
c. (i) Will navigational aids be required as a result of the project? d. (i) Will wetlands be crossed in transporting equipment to project
❑Yes ®No ❑NA site? ❑Yes ®No ❑NA
(ii) If yes, explain what type and how they will be implemented. (ii) If yes, explain steps that will be taken to avoid or minimize
environmental impacts.
10 / & ! 6 g plicant Signature
SR 1103 (Esclip Rd) pipe replacement
Project Name
Clay Willis, Environmental Officer
plicant Name
Z%yX�0�
2 s2•808-2303 ,. 3-8884RCO ST .. avv_spar..nccoastalmara ��rraent.fa�*# revised. 12 26i06

Form OCIIMIS
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):
d. Water depth at the proposed crossing at NLW or NWL:
e. (i) Will proposed bridge replace an existing bridge? ❑Yes ❑No f
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)
(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)
g•
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:
I. 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:
2.
CULVERTS
El This section not applicable
a.
Number of culverts proposed: 2
b. Water body in which the culvert is to be placed:
Mill Dam Creek.
< Form continues on back>
c.
Type of culvert (construction material):
2 - 60' x 117" x 79" CAAPA
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i
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: 60'
h. Height of the top of the proposed culvert above the NHW or NWL.
0'
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'
(iii) Width of existing culvert(s): 72"
(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) All
9• Width of proposed culvert: 1 17"
i. Depth of culvert to be buried below existing bottom contour.
1'
k. Will the proposed culvert affect existing water flow?
®Yes ❑No
If yes, explain: Enhance hydrologic flow regimes.
3. EXCAVATION and FILL ❑This section not applicable
a. (i) Will the placement of the proposed bridge or cuive. L require any b. (i) Wiii the piacerneni 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: 20' feet affected.
(iii) Avg. width of area to be excavated: 23' ❑CW ❑SAV ❑SB
(iv) Avg. depth of area to be excavated: 2' OWL ®None
(v) Amount of material to be excavated in cubic yards: 34
(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: 43'
(iii) Avg. width of area to be excavated: 25'
(iv) Avg. depth of area to be excavated: 4'
(v) Amount of material to be excavated in cubic yards: 159
252-808-28�8 :: 1-88$-4111COAST :: www.nccoastalman gel egg.ra t revised: it9i281436

Form DCM 61 P- (Bridges and Cugverts, 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 approved waste area site.
(ii) Dimensions of the spoil disposal area: N/A
(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: 60'
(iii) Avg. width of area to be filled: 4'
(iv) Purpose of fill: Rip rap 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:
(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:
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. Using NCDOT best management practices for erosion and
sediment control.

FGTM OQUJ AP-5 (Bridges and Culverts, Page 4 of 4)
It 1,•
e. What type of construction equipment will be used (for example,
dragline, backhoe, or hydraulic dredge)?
tracked excavator, dumptruck, backhoe
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
SR 1103 (Esclip Rd) Pipe Replacement
Project Name
Clay Willis, Environmental Officer
plicant Nlaine v
P
plicant 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.
�S f3�• ? ;; t.t �At� �! :: www.nccoastaimanaclernent.net revised. 1T26;{&6