57906_NCDOT_20110615

❑LAMA / ❑DREDGE &FILL
G E N FE;AL PERMIT Previous permit #
❑C�New odification El 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
Applicant Name
Address
City State ZIP
Phone # ( ) Fax # ( )
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
❑ Rules
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City. ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity-
T
(Scale: )
Pier (dock) length
Platform(s)
Finger piers)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore`
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
i
-
i `
j
Shoreline Length F'
SAV: not sure yes 1po
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no _
Waiver Attached: yes no j
A building permit may be required by: ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
r,
Permit Officer's Signature
Signature Please read compliance statement on back of permit **
Application Fee(s)
Check #
Issuing Date
Local Planningf urisdiction
Expiration Date
Rover File Name

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certifythat this project is consistentwith 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/ 1-888ARCOAST
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

N"6AMA / VDREDGE & FILL N O 57906
GENERAL PERMIT Previous permit# —
QKiew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources . 3 R _�L 3 C tj
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC U
Applicant Name
Pro
Project Location: County
©4rules attached.
ts�
Address 13 r ��°
i f O 4'
Street Address/ State Road/ Lot #(s) J < H 9 3
City 7�
State ! " ` f ZIP
Phone # ( �f
# (�
Subdivision
Authorized Agent j�� i�iF -r
City �' ^J ° ` k
pi ZIP 7 `I 13
ElCW ElEW
.,:
El PTA ❑ ES ❑ PTS
Phone # ()
River Basin v <✓� w
Affected
AEC(s): ❑ oEA El [IIH ❑ UBA El
Adj. Wtr. Body k 6 f� /unkn)
❑ PWS:
❑FC:
man
y W
CI tMW B d
ORW: yes / Co no PNA yes / Crit.Hab. yes / no W.—a). tr. o y
IN
MEN M ME MEN
M.
IIIII
IN
MEIN
III
IN
0
DNONE
AM
Mon,
swag
0
MEMO
MEN
MMIMEN
No
1
SEEM
NONE
MIEMN
0
00
M
ENO
ENO
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IN
I
NONE
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0
MEMEMENEMMMMEM
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0
MMMEIIMMMMMMM
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NONE
SEEN
MENEEMENS
IMMENSE MEMEN
1-�-t-
Agent or Applicant P to ame Permit Officers Signature
Signat re Please read compliance statement on back of permit",Issuing Date 3 b pi oigniDe�, N
qa® O,,r,�1'- jl. o:L,. 1l 6t'rr1�"u�k �, fir°�r.7 13 L✓
Application Fee(S) Check # Local Planning Jurisdiction Rover File Name

CDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
&eveiiy Eaves perdr'e; Governor James H. Grewson, Dirrodor Dee Freeman; Secretary
June 15, 2011
Clay Willis, Environmental Officer
Division 1
NC .Dept. of Transportation
1 i 3 Airport road, Suite 100
Edenton, NC; 27y32
Dear Mr. Willis:
Attached is General Permit #57306C.
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 riot 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,
,4'./�"
Stephen Lane
Coastal Management Representative
SLiisb
Enclosures
400 Commerce Avenue, Morehead City, North Carolina 25557
Phone: [phone]'kt=AX: 252-247-33301Internet: wwv. nccoastalmanagement. net
An Equai Opportunity t AffirmaUve Action Employer-50% necyrled 140% Post Consumer Paper

applicant:
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
ternimpacts)
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
ternimpacts)amount
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
1 `
W<fi�
Dredge ❑
Fill Both ❑
Other ❑
D- 6
Q
`✓h
Dredge ❑
Fill ❑
Both [" Other ❑
G
bredge ❑
Fill ❑
Both ty' 0ther ❑
zfl0
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 ❑
a ..3^vi3•�?... .. I-z1r1 .r4,:?C0A3T ..

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
May 26, 2011
Stephen Lane
NC Division of Coastal Management
400 Commerce Ave.
Morehead City, NC 28557
Dear Mr. Lane,
RECEIVED
JUN 3 2011
i
Dee-mm my
EUGENE A. CONTI, JR.
SECRETARY
This letter is requesting a general permit .2300 be issued for a pipe replacement on SR 1143 Hampton
Rd, 300' west of Worthguard Rd, in Currituck County. The current pipe is failing and needs to be replaced
to ensure safe public travel. The existing pipe (1 @ 22' x 18" CMP) will be replaced with the proposed pipe
(1 @ 25' x 30" CAA). The road shoulder at the inlet and outlet of the pipe will be stabilized with rip -rap.
The Division of Coastal Management considers the project area to be within an AEC that requires
authorization for the pipe replacement. Included with this request are the MP-1, MP-2, MP-5 forms,
location map, landowner notices, and permit drawings depicting the proposed work. The WBS element # is
1.202721. If any additional information is needed please contact Clay Willis at 252-482-7977.
Sincerely,
Jerry Jennings, P.E.
Division Engineer, Division One
Clay Willis
Environmental Officer, Division One
113 Airport Drive, Suite 100, Edenton, NC 27932, Phone [phone], Fax [phone]

UNITED STAT oSTAL SERVICE
• Sender: Please print your name, address, and ZIPI*Wfi this box
NO DEPT OF TRANSPOri iA1,_
DIVISION OFFICE
113 AIRPORT DRIVE, SUITE 100
EDENTON, NO 27932
COURIER: 10-51-02
I1l�EIIIF!liE1}iFF�F3l1�}j�F!#SillFtliFf!!�!f!}}}�I?!►lf31IkFI
UNITED STATES POSTAL SERVICE
• Sender: Please print your name, address, and ZIP+4`Ih its box •
NO DEPT OF TRANSPORTAM-
DIVISION OFFICE
113 AIRPORT DRIVE, SUITE 10r
EDENTON, NO 27932
COURIER:10-51-02
{!l�Fl�?li1�FiFFFIII}}?itl�}!�!IliF}1!}FiiiFFlf}!flFliiFFil?FI

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Gregory L. Conn
P.O. Box 126
Coinjock, NC 27923
2. Article Number
(Transfer from service label)
PS Form 3811, February 2004
A. Signature
❑ Agent
X d `/�—� El Addressee
B. Received b ( Printe Name) C. Date of Delivery
n 5-1..3
D. Is delivery addre different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
7009 2820 0003 3738 3968
Domestic Return Receipt
102595-02-M-1540

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Five C's Inc.
P.O. Box 1482
Elizabeth City, NC 27909
A. Sign re
Agent
X U ❑Addressee
B. Received by (Printed e) C. Date of Delivery
S-!
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Se ice Type
Zertified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7009 2820 0003 3738 3951,
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

(Domestic
For d elivery Inforination
visit our
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(Endorsement Required)
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Total Pnstana R Faas
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Gregory L. Conn
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P.O. Box 126
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27923
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- Five C's Inc.
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P.O. Box 1482
orF Elizabeth City, NC 27909
Ciry

Currituck County SR 1143 (Hampton Rd)

Currituck SR 1143 Hampton Rd
Riparian Landowners
P
-' Five C's Inc.
4W (108 Hampton 1
�` r PO Box 1482
.Gregory L. Cgnn
Elizabeth City, NC
(120 Hampton Rd)
PO Box 126
1 NC 27923 r

HAMPTON RD. (SR 1143)
CURRITUCK COUNTY
PIPE REPLA CEMENT
FIVE C S INC.
PO BOX 1482
ELIZABETH CITY ,NC 27909
DB 503 P 813 \
FMSMW EARTH SLOPS AS REQUIRED
INTERCOASTAL WATERWAY CANAL
DOCK
PROPOSED R/W
45.00'
TO ITO
HWY 15------XISTING PIPE 1(�18'X22'CMPBE REMOVED
PROPOSED RIP RAP
AT END OF PIPE
FIVE C S INC.
PO BOX 1482
ELIZABETH CITY ,NC 27909
DB 503 P 813
I/ PROPOSED RIP RAP FOR SHOULDER STARUZAITON
w
HAMPTON RD.(SR 1143)
7'O DEAD END
IED 1 @ 30" X 25' CAA
DITCH
PROPOSED R/W
GREGORY L.CONN
PO BOX 126
CO]VOCK, NC 27923-0126
DB 377 P 796
X:-75.95358
Y.36.34287
NC DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS
COUNTY DARE COUNTY
QUAD COINJOCK
BASIN -a PASQUOTANK
PROJECT o PIPE REPLACEMENT
SCALE P= 30'
DRAWN. JGC DATE. 4-19-2011

HAMPTON
RD. (SR
1143)
CL SR 1143
ELEV. 100.2'
PROPOSED RIP RAP
PROPOSED RIP RAP
AT END OF PIPE
so' 30
AT END OF PIPE
99.7'
100. ' 99.8'
_Z--
— — — — — — — — — — — — NWL 97.8
ft—_ — — — — — —— INVELEV96.8
EXISTING PIPE 1@18"X22'CMP �PROPOSED19 30" X25' CAA
TO BE REMOVED
DETAIL SECTION CROSS SECTION
NOTE: CLASS B STONE TO BE PLACED AROUND END OF PIPES
NOTE: BOTTOM OF NEW PIPE TO BE PLACED EXISTING PIPE
—
6" TO 1' BELOW SILT LINE
SR 1143 _ _ _ _ _ _ _ _CL ROAD ELEV. 100.2
— — — — — — — — — — — — — — — — — — — — — — — — — — —
r SHOULD LEV.99.7 INV ELEV 96.8 TOP of BAN -
NWL 97.8
EXISTING STREM BED
ELEV.97.2' EXISTING PIPE 1@18"X22'CMP PROPOSED1@ 30" X25' CAA
TO BE REMOVED PROPOSED RIP RAP
AT END OF PIPE
LINE AA DETAIL END SECTION VEI W
PROPOSED PIPE
NC DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS
COUNTY � DARE COUNTY
QUAD ° COINJOCK
BASIN PASQUOTANK
PROJECT ° PIPE REPLACEMENT
SCALE � 1" = 10'
DRAWN-. JGC DATE - 4-19-2011

ON MP-1
APPLICATION for
major Development Permit
(last revised 12/27/06)
North Carolina DIVISION OF COASTAL MANAGEMENT
1. Primary Applicant(Landowner Information
Business Name
N.C. Department Of Transportation
Project Name (if applicable)
SR 1143 (Hampton Rd) pipe replacement
Applicant 1: First Name
Clay
MI
Last Name
Willis
Applicant 2: First Name
MI
Last Name
ff 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 .. 1-888-4RCO ST .. www.ncc oastairnarwageme nt.ne:t

corm DCM MP-1 (Page 2 of 5)
APPLICATION for
Major Development Permit
3. Project Location
County (can be multiple)
Street Address
State Rd. #
Currituck
SR 1143 (Hampton Rd), 300' west of Worthguard Rd
SR 1143
Subdivision Name
City
State
Zip
Coinjock
NC
27923 -
Phone No.
Lot No.(s) (if many, attach additional page with list)
- - ext.
a. In which NC river basin is the project located?
b. Name of body of water nearest to proposed project
Pasquotank
Intercoastal Waterway (Coinjock Canal)
c. Is the water body identified in (b) above, natural or manmade?
d. Name the closest major water body to the proposed project site.
❑Natural ®Manmade ❑Unknown
Coinjock Bay
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.
n/a
4.
Site Description
a.
Total length of shoreline on the tract (ft.)
b. Size of entire tract (sq.ft.)
20'
1200
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 on a maintained shoulder.
f.
Man-made features and uses now on tract
SR 1143
g.
Identify and describe the existing land uses adiacent to the proposed project site.
Residential homes located along the ICW (Coinjock Canal).
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)
252-808-2aos . 1-888-4RCOAST .. www.fr c yaw: a x:a b r�wa e�rr�er�t.�ra i

Form DCM MP-1 (Page 3 of 5)
APPLICATION for
Major Development Permit
n. Describe existing wastewater treatment facilities.
None
o. Describe existing drinking water supply source.
None
p. Describe existing storm water management or treatment systems.
None
5. Activities and Impacts
a. Will the project be for commercial, public, or private use? ❑Commercial ®Public/Government
❑Private/Community
b. Give a brief description of purpose, use, and daily operations of the project when complete.
The purpose of this project is to replace the existing pipe that is structuarlly failing on SR 1143.
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.
d. List all development activities you propose.
Replace the existing pipe 1 @ 22' x 18" Corrugated Metal Pipe with 1 @ 25' x 30" Corrugated Aluminum Pipe.
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? 80 ®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 1143.
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) — (f) 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 52-808-2803 .. 1-888-4RCOAST .. www.necoastalmanagerne nt.net

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 Denise L. Mann
Phone No.
Address 104 Hampton Rd
Coinjock, NC 27923
Name Five C's Inc.
Phone No.
Address PO Box 1482
Elizabeth City, NC 27909
Name Gregory L. Conn
Phone No.
Address PO Box 126
Coinjock, NC 27923
g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, permittee, and issuing dates.
h. Signed consultant or agent authorization form, if applicable.
i. Wetland delineation, if necessary.
j. A signed AEC hazard notice for projects in oceanfront and inlet areas. (Must be signed by property owner)
k. A statement of compliance with the N.C. Environmental Policy Act (N.C.G.S. 113A 1-10), if necessary. If the project involves expenditure
of public funds or use of public lands, attach a statement documenting compliance with the North Carolina Environmental Policy Act.
7. Certification and Permission to Enter on Land
I understand that any permit issued in response to this application will allow only the development described in the application.
The project will be subject to the conditions and restrictions contained in the permit.
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 �. AA Print Name _Clay Willis, Environ ental Officer
Signature
:252-€l,0B-2808 1-888-4RC(").A`T w+tvvv nr-coastatmanagement. net

Form DCM MP-1 (Page 5 of 5)
APPLICATION for
Major Development Permit
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
n a2-808- 808 .. 'i-888-4RCO ST wwt-j.nc-coastaimana ement.net

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
(NLW or
Canal
Boat Basin
Boat Ramp
Rock Groin
Rock
Breakwater
(excluding
shoreline
NWL)
stabilization)'
Length
Width
Avg. Existing
NA
NA
Depth
Final Project
NA
NA
Depth
1.
EXCAVATION
®This section not applicable
a.
Amount of material to be excavated from below NHW or NWL in
b.
Type of material to be excavated.
cubic yards.
c.
(i) Does the area to be excavated include coastal wetlands/marsh
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
OWL ❑None
(ii) Describe the purpose of disposal in these areas:
.•,t'.-
' De.-, `E 4$ie :.. e•.'$' i.'8-4RCE A5T

3. SHORELINE STABILIZATION ❑This section not applicable
(If development is a wood groin, use MP-4 — Structures)
a. Type of shoreline stabilization: b. Length: 13'
❑Bulkhead ®Riprap ❑Breakwater/Sill ❑Other: Width: 2'-3'
c. Average distance waterward of NHW or NWL: 2' d. Maximum distance waterward of NHW or NWL: 3'
e. Type of stabilization material:
riprap
g. Number of square feet of fill to be placed below water level.
Bulkhead backfill Riprap 26
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.
riprap
4. OTHER FILL ACTIVITIES This section not applicable
(Excluding Shoreline Stabilization)
a. (i) Will fill material be brought to the site? ❑Yes ❑No ❑NA b. (i) Will fill material be placed in coastal wetlands/marsn (c;vv),
If yes, submerged aquatic vegetation (SAV), shell bottom (SB), or
other wetlands (WL)? If any boxes are checked, provide the
(ii) Amount of material to be placed in the water number of square feet affected.
(iii) Dimensions of fill area ❑CW ❑SAV ❑SB
(iv) Purpose of fill OWL ❑None
(ii) Describe the purpose of the fill in these areas:
5. 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?
❑Yes ®No ❑NA
(ii) If yes, explain what type and how they will be implemented.
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.
Clay Willis, Division Environmental Officer
Date Applicant Name
SR 1143 (Hampton Rd) pipe replacement
Applicant Signature
Project Name

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)
9• Length of proposed bridge:
i. Will the proposed bridge affect existing water flow? ❑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:
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 ❑ This section not applicable
a• Number of culverts proposed: 1 b. Water body in which the culvert is to be placed:
Intercoastal Waterway (Coinjock Canal).
< Form continues on back>
c. Type of culvert (construction material):
1 - 25' x 30" Corrugated Aluminum Pipe
r .::10126106

For'M DGIVI_M- ( ridq s Brad OtIverts, 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: 25'
h. Height of the top of the proposed culvert above the NHW or NWL.
1'
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): 22'
(iii) Width of existing culvert(s): 18"
(iv) Height of the top of the existing culvert above the NHW or
NWL: 0.5'
(v) Will all, or a part of, the existing culvert be removed?
(Explain) All
9• Width of proposed culvert: 36"
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 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: 5' feet affected.
(iii) Avg. width of area to be excavated: 4' ❑CW ❑SAV ❑SB
(iv) Avg. depth of area to be excavated: 2' OWL ®None
(v) Amount of material to be excavated in cubic yards: 1_5
(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: 20'
(iii) Avg. width of area to be excavated: 4'
(iv) Avg. depth of area to be excavated: 2'
(v) Amount of material to be excavated in cubic yards: 6
252-808-2808 :: 1-888-4RCOAST :. vvvuvv.a2ccaastairnanagement.net revised. IOi26l06

t)Vr - (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 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: 13
(iii) Avg. width of area to be filled: 3=5'
(iv) Purpose of fill: Bank stabiliztion.
(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:
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
b. Will the proposed project require the construction of any temporary
utility lines? ❑Yes ®No
detour structures? ❑Yes ®No
If yes, explain:
If yes, explain:
If this portion of the proposed project has already received
approval from local authorities, please attach a copy of the
approval or certification.
< Form continues on back>
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 sediment
and erosion control.
25 -6 - d .. 1-886-4RCOAST :; w w.nccoastairnanagemgnt_taet revised.10!26106

Form DCM MP-5 (Bridges and C:slverts, Page 4 of
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 I
SR 1143 (Hampton Rd) pipe replacement
Project Name
Clay Willis, Environmental Officer
plicant Name
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.
252-808-2808 .: 1-888-4 Cc) i' :: www.nccoastalmanaQement.net revised- 10126/06

STATE OF NORTH CAROLINA
DEPARTWNT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
May 10, 2011
Denise L. Mann
104 Hampton Rd
Coinjock, NC 27923
To Whom It May Concern:
EUGENE A. CONTI, JR.
SECRETARY
CERTIFIED MAIL
The NC Department of Transportation is proposing to replace a metal pipe on SR
1143 Hampton Rd in Coinjock, Currituck County. The site is located approximately 300'
west of Worthguard Rd. The existing pipe is 1 @ 22' x 18" and will be replaced with 1
@ 25' x 30"Corrugated Aluminum Arch Pipe.
The Division of Coastal Management (DCM) considers this to be in an "Area of
Environmental Concern" under their regulations. Therefore, it is provided protection
under state law. For this reason the NCDOT will apply for a permit from the DCM to
perform the described work. Part of the permit process is notifying the adjacent
landowners of the proposed work. A map depicting the project area, along with a design
plat, and the permit application is included with this letter. If you have any questions
concerning the proposed work you can contact Clay Willis at 252-482-7977.
113 Airport Drive, Suite 100, Edenton, NC 27932, Phone [phone], Fax [phone]

The attached form is submitted to insure that you have an opportunity to comment
on the proposal. The work is depicted on the attached drawings. If you have no objects to
the proposal, please return the form with your response within ten (10) days to this office.
If you do have objections to the project, please forward your comments to:
Stephen Lane
NC Division of Coastal Management
400 Commerce Ave
Morehead City, NC 28557
No response within ten (10) days will be construed to mean you have no objections.
Thank you for your cooperation.
Sincerely,
Jerry Jennings, P.E.
Division Engineer, Division One
Clay Willis W"'
Environmental Officer, Division One

ADJACENT RIPARIAN LANDOWNER STATEMENT
(Currituck: SR 1143 Hampton Rd)
I, , am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the pipe
replacement on SR 1143 (Hampton Rd). I am further aware that this work will occur in
an AEC and therefore will require authorization from the Division of Coastal
Management in accordance with the Coastal Area Management Act (CAMA).
I have no objection to the project as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
are attached.
I have objections to the project as presently proposed and my comments
Signature of Adjacent Landowner
Date:

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
May 10, 2011
Five C's Inc.
PO Box 1482
Elizabeth City, NC 27909
To Whom It May Concern:
EUGENE A. CONTI, JR.
SECRETARY
CERTIFIED MAIL
The NC Department of Transportation is proposing to replace a metal pipe on SR
1143 Hampton Rd in Coinjock, Currituck County. The site is located approximately 300'
west of Worthguard Rd. The existing pipe is 1 @ 22' x 18" and will be replaced with 1
@ 25' x 30"Corrugated Aluminum Arch Pipe.
The Division of Coastal Management (DCM) considers this to be in an "Area of
Environmental Concern" under their regulations. Therefore, it is provided protection
under state law. For this reason the NCDOT will apply for a permit from the DCM to
perform the described work. Part of the permit process is notifying the adjacent
landowners of the proposed work. A map depicting the project area, along with a design
plat, and the permit application is included with this letter. If you have any questions
concerning the proposed work you can contact Clay Willis at 252-482-7977.
113 Airport Drive, Suite 100, Edenton, NC 27932, Phone [phone], Fax [phone]

The attached form is submitted to insure that you have an opportunity to comment
on the proposal. The work is depicted on the attached drawings. If you have no objects to
the proposal, please return the form with your response within ten (10) days to this office.
If you do have objections to the project, please forward your comments to:
Stephen Lane
NC Division of Coastal Management
400 Commerce Ave
Morehead City, NC 28557
No response within ten (10) days will be construed to mean you have no objections.
Thank you for your cooperation.
Sincerely,
Jerry Jennings, P.E.
Division Engineer, Division One
Clay Willis
Environmental Officer, Division One

ADJACENT RIPARIAN LANDOWNER STATEMENT
(Currituck: SR 1143 Hampton Rd)
I, , am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the pipe
replacement on SR 1143 (Hampton Rd). I am further aware that this work will occur in
an AEC and therefore will require authorization from the Division of Coastal
Management in accordance with the Coastal Area Management Act (LAMA).
I have no objection to the project as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
are attached.
I have objections to the project as presently proposed and my comments
Signature of Adjacent Landowner
Date:

k
a„a SCATFa
STATE OF NORTH CAROUNA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
May 10, 2011
Gregory L. Conn
PO Box 126
Coinjock, NC 27923
To Whom It May Concern:
EUGENE A. CONTI, JR.
SECRETARY
CERTIFIED MAIL
The NC Department of Transportation is proposing to replace a metal pipe on SR
1143 Hampton Rd in Coinjock, Currituck County. The site is located approximately 300'
west of Worthguard Rd. The existing pipe is 1 @ 22' x 18" and will be replaced with 1
@ 25' x 30"Corrugated Aluminum Arch Pipe.
The Division of Coastal Management (DCM) considers this to be in an "Area of
Environmental Concern" under their regulations. Therefore, it is provided protection
under state law. For this reason the NCDOT will apply for a permit from the DCM to
perform the described work. Part of the permit process is notifying the adjacent
landowners of the proposed work. A map depicting the project area, along with a design
plat, and the permit application is included with this letter. If you have any questions
concerning the proposed work you can contact Clay Willis at 252-482-7977.
113 Ali -port Drive, Suite 100, Edenton, NC 27932, Phone [phone], Fax [phone]

A- .,
The attached form is submitted to insure that you have an opportunity to comment
on the proposal. The work is depicted on the attached drawings. If you have no objects to
the proposal, please return the form with your response within ten (10) days to this office.
If you do have objections to the project, please forward your comments to:
Stephen Lane
NC Division of Coastal Management
400 Commerce Ave
Morehead City, NC 28557
No response within ten (10) days will be construed to mean you have no objections.
Thank you for your cooperation.
Sincerely,
Jerry Jennings, P.E.
Division Engineer, Division One
Clay Willis b 7
Environmental Officer, Division One

ADJACENT RIPARIAN LANDOWNER STATEMENT
(Currituck: SRI143 Hampton Rd)
I, , am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the pipe
replacement on SR 1143 (Hampton Rd). I am further aware that this work will occur in
an AEC and therefore will require authorization from the Division of Coastal
Management in accordance with the Coastal Area Management Act (CAMA).
I have no objection to the project as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
are attached.
I have objections to the project as presently proposed and my comments
Signature of Adjacent Landowner
Date:

ADJACENT RIPARIAN LANDOWNER STATEMENT
(Currituck: SR 1143 Hampton Rd)
I, f iax N - C__o\e— , am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the pipe
replacement on SR 1143 (Hampton Rd). I am further aware that this work will occur in
an AEC and therefore will require authorization from the Division of Coastal
Management in accordance with the Coastal Area Management Act (CAMA).
I have no objection to the project as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
are attached.
I have objections to the project as prese tly roposed and my comments
�q�
Signature of Adjacent Landowner
Date: - - /

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
LISPS
Permit No. G-10
• Sender: Please print your name, address, and ZiP+4 in this box •
NC DEPT OF TRANSPORTATION
DIVISION OFFICE
113 AIRPORT DRIVE, SUITE 100
EDENTON,NC 27932
COURIER: 10-51-02
1

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Denise L. Mann
104 Hampton Road
Coinjock, NC 27923
A. Signature
X ❑ Agent
❑ Addressee
B. Received by (Printed Name) I C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
z, Article Number 7009 2820 0003 3738 3944
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

NC DEPT OF TRANSPORTATION
DIVISION OFFICE
113 AIRPORT DRIVE, SUITE 100
EDENTON,NG 27932
COURIER:10-51-02
0 q O
i
S OO0 P -e NT A00
Sew � F
OAWAR AOOR OTH
i
RF Ap t�SF e I poFq
Denise L. Mann
104 Hampton Road
Coinjock, NC 27923
OAPS PON
O
v puma BOWLS
02 1M $ 06.41
0004267590 MAY12 20'
MAILED FROM ZIP CODE 2,a