56373_NC DOT_20110425 (2)

L'� CAMA / C�DREDGE & FILL
1 1 6 v v v I v
GENERAL PERMIT
Previous permit#
'Clew ❑Modification ❑Complete Reissue El Partial Reissue
Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and
Natural Resources I
and the Coastal Resources Commission in an area of environmental concern pursuant
to 15A NCAC�
,r t
[�R'ules attached.
Location: County
Applicant Nam
Project
If —A' 7
Address
Street Address/ State Road/ Lot #(s)
�-� �C:,v� )--7cd'
City State ZIP
Phone # Fax# (_)
Subdivision
Authorized Agent %.' % ��
City �%tu� ZIP
yCW [�Jf� [3'lTA ['}ES ❑ PTS
Phone # ( ) River Basin
Affected
UBA ❑ N/A
AEC (s) : ❑ OEA ElHHF ElIH ElAdj.
Ll j-r ,tea -W YNT"t 6-
Wtr. Bod y (at lman /unkn)
O PWS: ❑FC:
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ORW: yes /(nol PNA byes)/ no Crit.Hab. yes / no
Closest Maj. Wtr. Body
NONE
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NONE No
MENEM ENE
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Jeff 'Yaly,111
Will
Agent or Applicant Printed Name
Sign ture ** Please read compliance statement on back of Permit "
Application Fee(s) Check #
Permit Officers Signature
c l,:) -' /l J /-/ �
Issuinepate Expiratigp ptte
b' S"1 N
Local Planning Jurisdiction Rover File Name
'J

naplicant:
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.
DISTURB TYPE
Habitat Name Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
tempimpacts
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
tempimpacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
i /
V
Dredge ❑ Fill ElBoth [Other ❑
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Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
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NCDENR
North Carolina Department of Environment and
Division of Coastal Management
Beverly Eaves Perdue
Governor
April 26, 2011
NCDOT
P.O. Box 1587
Greenville, N.C. 27835
Dear Mr. Johnson:
James H. Gregson
Director
Natural Resources
Dee Freeman
Secretary
Attached is General Permit #56373C to replace a 72" X 40' culvert with a 73" X 53" X 40' culvert on SR 1325,
Merritt, Pamlico County, North Carolina.
In order to validate this permit, please sign the permit as indicated. Retain the white copy for your files and
return the signed yellow and pink copies to us in the enclosed, self-addressed envelope. If the signed permit
copies are not returned to this office before the initiation of development, you will be working without
authorization and will be subject to a Notice of Violation and subsequent civil penalties.
We appreciate your early attention to this matter.
Sincerely,
Stephen Lane
Coastal Management Representative
rcb
Enclosures
400 Commerce Ave., Morehead City, INC 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastaimanagement.net
An Equal Opportunity 1 Affirmative Action Employer
NorthCarolina
;Vaturall'ff

190 OF4
APPLICATION for
Major Development Permit
(last revised 92t27/06)
North Carolina DIVISION OF COASTAL MANAGEMENT
1. Primary Applicant/ Landowner Information
Project Name (if applicable)
Business Name
NI-2028 Pipe Replacement SR 1325, Brown Creek Road
North Carolina Department Of Transportation
Over U/T Brown Creek Township Number 2 WBS Element
Number 2B.206911
Applicant 1: First Name
MI
Last Name
Jay
B.
Johnson
Applicant 2: First Name
MI
Last Name
If additional applicants, please attach an additional page(s) with names listed.
Mailing Address
PO Box
City
State
1587
Greenville
NC
ZIP
Country
Phone No.
FAX No.
27835 1587
US
252 - 830 - 3490 ext. 248
252 - 830 - 3341
Street Address (if different from above)
City
State
ZIP
Email
[e-mail]
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>

Form DCM MP-1 (Page 2 of 5)
APPLICATION for
MAR 14 2011 Major Development Permit
3. Project Location
County (can be multiple)
Street Address
State Rd. #
Pamlico
SR 1325, Brown Creek
Road
Subdivision Name
City
State
Zip
Phone No.
Lot No. Is) (if many, attach additional page with list)
- - ext.
I ,
a. In which NC river basin is the project located?
b. Name of body of water nearest to proposed project
Neuse
U/T Brown 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
Brown 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.)
90' (45' East and 45' West)
N/A
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)
3.5' ❑NHW or ®NWL
e.
Vegetation on tract
Maintained Roadside Grasses
f.
Man-made features and uses now on tract
Road
g.
Identify and describe the existing land uses adjacent to the proposed project site.
Residential Property
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. OYes No ®NA
If yes, by whom?
1.
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)

Form DCM MP-1 (Page 3 of 5)
APPLICATION for
MAR 14 Mor Development Permit
n. Describe existing wastewater treatment facilities. MM_MHD MY
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 NPublicdGovemment
❑Private/Community
b. Give a brief description of purpose, use, and daily operations of the project when complete.
The Existing 72" x 40' CMP Will Be Replaced By a Proposed 73"x 53" x 40' CAAPA. The Proposed Pipes Will Keep The
Roadway From Collapsing, Thus Preventing Possible Injury and Death.
c. Describe the proposed construction methodology, types of construction equipment to be used during construction, the number of each type
of equipment and where it is to be stored.
The Existing Pipes Will Be Removed and the Proposed Pipes Will Be Installed. Typical Roadway Construction Equipment
Will Be Used, Including,But Not Limited To Tracked Excavators,Dump Trucks, Flat -Bed Trucks,Back-Hoes,And Boom
Trucks.
d. List all development activities you propose.
Pipe Replacement and Asphalt Patching
e. Are the proposed activities maintenance of an existing project, new work, or both? Both
f. What is the approximate total disturbed land area resulting from the proposed project? 440 NSq.Ft or ❑Acres
g. Will the proposed project encroach on any public easement, public accessway or other area ❑Yes ❑No NNA
that the public has established use of?
h. Describe location and type of existing and proposed discharges to waters of the state.
N/A
i. Will wastewater or stormwater be discharged into a wetland? Yes NNo ❑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 NNo ❑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) — (t) 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.

Form DCM MP-1 (Page 4 of 5)
RECEraD
APPLICATION for
MAR 14 2011 Major Development Permit
d. A copy of the deed (with state application only) or other instrument under which the applicaHCTWfp1gt"e 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 Weyerhaeuser Company,lnc. Timberlands Acct/Land Records
Phone No.
Address 1785 Weyerhaeuser Road Vanceboro, NC 28586 Parcel K07-16-3
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.
None
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 T-f
lication tTth,,,fu,1,to the best of my knowledge.
Date Print Name
Signature
Please indicate application attachments pertaining to your pr sect teLt.
❑DCM MP-2 Excavation and Fill Information ❑D MP-5 Bridges and Culverts
❑DCM MP-3 Upland Development
❑DCM MP-4 Structures Information

Form DCM MP-1 (Page 4 of 5)
7 CE
APPLICATION for
MajVylomi permit
d. A copy of the deed (with state application only) or other instrument under which the applicant claims title to the affaMfroperties.
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 Harry L. Myers and Delma K. Heine Myers
Phone No.
Address 2436 Browns Creek Road Merritt, NC 28556 Parcel K07-24-21
Name Mack C. Kirkman, Heirs
clo Haywood Kirkman
Phone No.
Address 9008 Ray Road Raleigh, NC 27613 DBK. 110, Pg. 455 L08-6
Name Joseph D. McClees and Henri S. Johnson
Phone No.
Address P.O. Box 430 Oriental, NC 285714 Parcel L08-1
g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, permittee, and issuing dates.
None
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 February 24, 2011 Print Name _Jay B. Johns n
Signature
Please indicate application attachments pertaining to your propos d proj
®DCM MP-2 Excavation and Fill Information ®DCM MP-5 Bridges and Culverts
❑DCM MP-3 Upland Development

Form DCM MP-2
EXCAVATION and FILL
(Except for bridges and culverts)
RECEIVED
APR 6 2011
DCM-MHD CITY
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
(NSW or
Breakwater
shoreline
NWL)
stabilization
Length
Width
Avg. Existing
NA
NA
Depth
Final Project
NA
NA
Depth
9. EXCAVATION ®This section not applicable
a. Amount of material to be excavated from below NHW or NWL in b. Type of material to be excavated.
cubic yards.
C. (i) Does the area to be excavated include coastal wetlands/marsh
(CW), submerged aquatic vegetation (SAV), shell bottom (SB),
or other wetlands (WL)? If any boxes are checked, provide the
number of square feet affected.
❑CW ❑SAV ❑SB
OWL ❑None
(ii) Describe the purpose of the excavation in these areas:
2. DISPOSAL OF EXCAVATED MATERIAL
of disposal area.
a (i) Do you claim title to disposal area?
❑Yes ❑No ❑NA
(ii) If no, attach a letter granting permission from the owner.
e. (i) Does the disposal area include any coastal wettands/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 ❑SS
OWL ❑None
(ii) Describe the purpose of disposal in these areas:
d. High -ground excavation in cubic yards.
®This section not appficab/e
b. Dimensions of disposal area.
d. (i) Will a disposal area be available for future maintenance?
[]Yes ❑No ❑NA
(4) If yes, where?
f. (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)

a. Type of shoreline stabilization: b. Length: 90' (46 East And 45' West)It RECEIM
❑Bulkhead ®Riprap ❑BreakwaterlSill ❑Other: Width: 3'
c. Average distance waterward of NHW or NWL: 7 d. Maximum distance waterward of NHW or NWL: 3' APR 6 2011
e. Type of stabilization material:
Class B Marl
g. Number of square feet of fill to be placed below water level.
Bulkhead backfill Riprap 45 x S = 135 S% Ft.East
and West Total = 270 Sq. Ft.
Breakwater/Sill Other
i. Source of fill material.
Clark's Quarry
f. (i) Has there been shoreline erosion during precedin?)84-MHD Crry
months?
❑Yes ®No ❑NA
(ii) If yes, state amount of erosion and source of erosion amount
information.
h. Type of fill material.
Class B Marl
4. OTHER FILL ACTIVITIES ®This section not applicable
(Excluding Shoreline Stabilization)
a. (i) Will fill material be brought to the site? ElYes No ONA b. (i) Will fill material be placed in coastal wetlandsimarsh (CW),
If yes,
(ii) Amount of material to be placed in the water
(iii) Dimensions of fill area
(iv) Purpose of fill
submerged aquatic vegetation (SAV), shell bottom (SB), or
other wetlands (WL)? It 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 i
a. How will excavated or fill material be kept on site and erosion b. What type of construction equipment wift be used (e.g., dracline,
controlled? backhoe, or hydraulic dredge)?
Sift Fences and TRSC-B's Typical Road Construction Equipment
C. Cl) Will navitional aids be required as a result of the project? d. (i) Will wetlands be crossed in transporting equipment to project
❑Yes lNo ❑NA site? ❑Yes ®No ❑NA
(6) If yes, explain what type and tow they will be implemented. (ii) If yes, explain steps that will be taken to avoid or minimize
environmental impacts.
ry 24, 2011 Revised March 31, 2011
Date
SR 1325,Brown Creek Road Over U/T Brown Creek NI-2028
Pamlico County Pipe Replacement WBS Element Number
2B.201611
Project Name
Jay B. Johnson
plicant Name
pticant

Form aeM MP-5
RRinAEc any P.iuuFerc
kAR 14 2011
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:
❑Commercial ❑PublictGovernment ❑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:
b. Water body to be crossed by bridge:
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:
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 ❑This section not applicable
a• Number of culverts proposed: 1
b. Water body in which the culvert is to be placed:
U T Brown Creek
< Form continues on back>

POr_f" l - i) NIP-5 (Bridges and Culverts, Page 2 of 4)
e y���.,�,,,�,�
DIVED
c. Type of culvert (construction material):
CMP
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: 40'
h. Height of the top of the proposed culvert above the NHW or NWL.
2.3"
j. Will the proposed culvert affect navigation by reducing or
increasing the existing navigable opening? ❑Yes ®No
If yes, explain:
MAR 14 2011
DCM-11i M CITY
e. (i) Will proposed culvert replace an existing culvert?
®Yes ❑No
If yes,
(ii) Length of existing culvert(s): 40'
m Width of existing culverts 72' G
(iv) Height of the top of the existing culvert above the NHW or
NWL.- 2.3'
(v) Will all, or a part of, the existing culvert be removed?
(Explain) All of the Existing Culverts Will be Replaced
9• Width of proposed culvert: 73"
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:
3. EXCAVATION and FILL [I This section not applicable
a. (i) Will the placement of the proposed bridge or culvert require any b.
excavation below the NHW or NWL? ®Yes ❑No
If yes,
(ii) Avg. length of area to be excavated: East 4' West 4'
(iii) Avg. width of area to be excavated: 44' North 44' South
(iv) Avg. depth of area to be excavated: 1_0'
(v) Amount of material to be excavated in cubic yards: 13
Cubic Yards
C.
(i) Will the placement of the proposed bridge or culvert require any
high -ground excavation? ®Yes [:]No
If yes,
(ii) Avg. length of area to be excavated: 40'
(iii) Avg. width of area to be excavated: 10'
(iv) Avg. depth of area to be excavated: 1_0'
(v) Amount of material to be excavated in cubic yards: 14
Cubic Yards
(i) Will the placement of the proposed bridge or culvert require any
excavation within coastal wetlands/marsh (CW), submerged
aquatic vegetation (SAV), shell bottom (SIB), or other wetlands
(WL)? If any boxes are checked, provide the number of square
feet affected.
ECW 45 Sq. Ft. ❑SAV ❑SB
OWL ❑None
(i) Describe the purpose of the excavation in these areas:
Excavation for Pipe Bedding

Fors IDs";!il PIP-5 (Bridges and Culverts, Page 3 of 4) RECEIVED
d. If the placement of the bridge or culvert involves any excavation, please complete the following: MAR 14 2011
(i) Location of the spoil disposal area: Temporary Spoil Area is in the Existing Road
(ii) Dimensions of the spoil disposal area: 100' x 200' DCM-MffD CITY
(iii) Do you claim title to the disposal area? ®Yes El 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 f. (i) Will the placement of the proposed bridge or culvert result in any
fill (other than excavated material described in Item d above) to fill (other than excavated material described in Item d above) to
be placed below NHW or NWL? ®Yes ❑No be placed 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 filled: North 4' South 4' feet affected.
(iii) Avg. width of area to be filled: 10' ®CW 144 Sq. ft. ❑SAV ❑SB
(iv) Purpose of fill: Pipe Bedding OWL ❑None
(ii) Describe the purpose of the excavation in these areas:
Fill for Proposed Pipe and Class B Stone
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:
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>

r or rig OCNI AMP-5 (Bridges and Culverts, Page 4 of 4)
c. Will the proposed project require any work channels? d. How will excavated or fill material be kept on 0ite� rosion
❑Yes ®No controlled?
If yes, complete Form DCM-MP-2. Turbidity Curtains and Silt Fences will be used to r tf reo%j
sediment on -site
e. What type of construction equipment will be used (for example,
dragline, backhoe, or hydraulic dredge)?
Typical Bridge Construction Equipment
g. Will the placement of the proposed bridge or culvert require any
shoreline stabilization? ®Yes ❑No
If yes, complete form MP-Z Section 3 for Shoreline
Stabilization only.
February 24,2011
Date
SR 1325, Brown Creek Road NI-2028 Over U/T Brown Creek,
Pipe Replacement, Pamlico County WBS Element Number
2B.206911
Project Name
Jay B. Johnson
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.

RECEIVED
NORTH CAROLINA
DL.PARTMENT OF TRANSPORT Al ION
DIVISION TWO, BRIDGE_ MAINTENANCE
NEW BERN, N.C.
K07-24-21
HARRY L.MYERS AND DELMA
K. HEINE MYERS
2436 BROWN CREEK ROAD
MERRITT, NC 28556
DBK. 355, Pg.126
PCA 1I7 -2
AREA /
24 50. FT.
COASTAL IMPACT
APR 6 2011
PROPOSED $t%MENT
P-2028 PIPE REPLACEMENT PAMLICO: P-2028
WBS ELEMENT NUMBER 2B206911 p v PAMLICO COUNTY, DATE_1/25/20i1
DRAWN BY: T.CASEY
TRIBUTARY TO SR 1325,BROWN CREEK ROAD
BROWNS CREEK OVER U/T BROWN CREEK
20 30' 30' 20� NEUSE RIPARIAN BUFFER RULES APPLY
BUFFER sarrig eupFea ZONE ZONE L 08-6
REVISED: MARCH 31,2011
z zat
? TIDAL ?
N
FLOW
9/
BUFFER ZONE //MP,4CTS = 40 SO. FT.
BUFFER ZONE 2 IrVPACTS =O SO. FT.
STREAM IMPACTS =5 LINEAR FT
— — — — — — — — — — — — — — -- — --
LL T T
PROPOSED RIP I AP
MACK C. ICIRKMAN, HEIRS AREA 2
c/o HAYWOOD KIRKMAN 30 SO FT.
9008 RAY ROAD COASTAL IMPACT
RALEIGH, NC 27613 92
DBK. I10, Pg. 4559UFFT19 ZONE /IMPACTS = 40 SO FT.
BUFFER ZONE 2 /MP,4CTS - 0 SO, FT
STREAM 1VP,4CT5 = 0 LINEAR FT
TU BIDITY CURTAIN R/W
------------------------ - - - --- SHOULDER POINT
-- -- -- ---------------------
TEMPORARY SILT FENCE I
EXISTING PIPE:1072'X40'CMP II EDGE OF PAVEMENT
II II-----0.4 MI. TO JCT SR-1321=— 60
-----------------��— --- C/L SR-1325
�— 1.3 M1. TO JCT. SR-1327 I II I9 BROWN CREEK ROAD
I I <-- PROPOSED PIPE: I073'X53'X40' CAAPA
II II (8 GAGE)
TEMPORARY SILT FENCE II EDGE OF PAVEMENT
-- - - - - - - - - - - - ----------- - -- - - SHOULDER POINT
PROPOSED RIP AP 3
K07-16-3
WEYERHAEUSER COMPANY
TIMBERLANDS ACCT/LAND RECORDS AREA 4
1785 WEYERHAEUSER ROAD 5/SO. FT.
VANCEBORO, NC 28586 COASTAL IMPACT
DBK. 340, Pg. 697
PORTION OF WHORTON TRACT 94
BUFFER ZONE /IMPACTS = 40 SO.
BUFFER ZONE 2 IMPACTS = 0 SO /
STREAM IMPACTS - 5 LINEAR FT.
CO,457,4L /MPACTS
AREA / 29 SO Fr r
/i/ILH G ✓v ✓v• . .•
AREA _3 39 50, FT _OP_ _EN RYA TER
-ARE,4 4 5/ SO FT, //L/R4CTS
7-07,4L . I99 SO FT. AREAS IS2: 45 SO. FT.
O. 003 ACRES AREAS JS 4 :33 50. FT
-t::�!T — — TU BIDITY CURTAIN J+— — R/W
"'*—EXISTING POWER POLE
T TIDAL
N
2o/ 30' FLOW 30' 20
�`� BUFFER BUFFER BN fE7
ZONE ZONE raw
1
NO TE: NOT TO SCALE
FOR PERMIT USE ONLY
AREA 3
39 SO, FT,
COASTAL IMPACT
L 08-I
JOSEPH D. MCCLEES AND
HENRI S. JOHNSON
P.O. BOX 430
ORIENTAL, NC 28571
DBK. 211,Pg. 819 B j
BUFFER ZONE /IMPACTS = 40 SO. FT,
BUFFER ZONE 2 IMPACTS = 0 SO F7,
STREAM IMPACTS =0 LINEAR FT

NI-2028
SR 1325,Brown Creek Road
Pamlico County
DETAIL SECTION - CROSS SECTION
I, 20'-V _ I
PROPOSED RIP RAP PROPOSED RIP RAP
PROPOSED 73' x 33" x 40' CAAPA -0+�- 0.D2 FWi 0.02 FM 0.04. WT. PROPOSED 73" x 83" x 40' CAAPA
EXISTING 72" x 40' CMP
EXISTING STREAM BED - - - - - - - - - - - - - - - I
- _ _ _ _ _ - - - - - - -EXISTING WATER SURFACE
PROPOSED PIPE BED
REPLACE EXISTING 72" x 40' CMP WITH 73" x 53" x 40' CAAPA
ELEVATIONS ARE BASED ON
ASSUMED DATUM.
q OF PAVEMENT
---- --- -------------------- ELEV. = 100.00'
PROPOSED RIP RAP
SYMBOLS
PROPOSED CROSS SECTION
- - - EXISTING CROSS SECTION
EXISTING EXISTING
STREAM BED WATER SURFACE NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
ELEV. = 98.3' DIVISION 2
- --- ------- - -- - -- P.O. BOX 158T G:
-------------- - - - - ------- - - - - -- -ELEV. = 95.6------- GREENVILLE NO 27835 [phone] \::<
ELEV. = 95.6'
PROPOSED
PIPE BED
NI -PROPOSED 73" x 53" x 40' CAAPA `I ` - Q° WBS412B208911
DETAIL SECTION - END VIEW
COUNTY:PAMLICO
QUAD: ORIENTAL QUAD DATE: FEBRUARY 24, 2011
BASIN:NEUSE SHEET #: 2 OF 2
SUBJECT NI.2028
EXISTING 72" x 40' CMP
TO BE REPLACED WITH PROPOSED 73" x 63" x 40' CAAPA
LAT. = 36.114589 N LONG. = 76.632187 W SCALE: 1" = 10'

l
P-2028 PIPE REPLACEMENT
PAMLICO COUNTY °`-
�— SR 1325, BROWN ROAD OVER U/T BROWN CREEK
ORIENTAL USGS QUAD MAPAND SHEET NUMBER 8
OF THE SOIL SURVEYOFPAMLICO COUNTY ZQ!!
FIRMPANEL 7500 BROWN CREEK SA;HQW;NS
MAP NUMBER 3 720 750000 J WBS ELEMENT NUMBER 2B.206911
LOWER NEUSE 03020204 FEBRUARY24, 2011
T N
__ l��a d I F[oreaceSrh x �.
r Zion Hill Ch''
E
S
cc
X3
P-2028
Y= 505076.4215
X=2 708017.63 77
_ I N 35.114589 DEGREES
W 76.632187 DEGREES �~
;=
01
r t 1 B�:1d . \`/ t�C srr�i4r p `'•+ }FS,f �
A
46
54
�\�c�� \� �.. } _� � 1 1r) _ � , a �y +'i1�jt'r�r�ta.K�,ri •'l.
% 1 inch = 2,000 feet �;s°'',`43y3,L�s3,f�`
I -'•,-;fir �,�� � f
0 750 1,500 3,000 4,500 6,000
Feet

UNITED STATES POSTAL SERVICE , .s
�;igg Fe Pai
• Sender: Please print your name, address, and ZIPT4`-ir tf is box •
N.C. Dept. of Transportation
PO Box 1587
Greenville, NC 27835
==�1:`1=?:F===' I' L1 1F 1 l:l `_ _:=H-* lil -11:f i
l.= i Ii. i:::l.;ii.: Fi£i IE F '-:f..... ifi?: fe:i
;'Am ClLD
UNITED
e & Paid
nyu
• Sender. Please print your name, address, and ZIP+4 in this box •
N.C. Dept. of Transportation
PO Box 1587
Greenville, NC 27835
"�'? f?:l:1f FF3EIF3lF?FIt?F131F3?Fflili[fl}{)}1=?:f1F:Fil?FFlf:t?il'� _ ZQ�
fr)
z

■ 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:
,4Jd2A2-y L. /YIyEW-S
3)"-MA k. A�-„ re Mxcks
a � 3 4, J6Row1Js C,ele -"-cl.
M40-zi7r; dG 2&56!o
A. Si natu e ❑ Agent
X ) ti' Addressee
B. eceiv b Printed Nam Da of �ivery
1✓1
D. Is delivery address different from item 1? Y
if YES, enter delivery address below: 13 Nb
3. Service We
45�6ertifled Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
4. Restricted Deliveryt ltxua reef
❑ Yes
2. Article Number
(transfer from service label) 7 010 1870 0001 0069 5773
102595-02•M-1540
PS Form 3811, February 2004 Domestic Return Receipt
�P
G

E.
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
1a.
Does the project include or is it adjacent to protected riparian buffers identified
® Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b.
If yes, then is a diffuse flow plan included? If no, explain why.
Comments: Sheet Flow through the Vegetated Shoulders and Special Sediment
Control Fence will be used to treat Stormwater Run -Off From the Road. New Pipes
Will Be Installed At Staion 17+00,Lt. And Rt.-L- to Replace Existing Pipes.
Stormwater Will Flow Through Wattles For Treatment. Roadside Ditches Will Not
Enter Into the buffers From Station 14+00 To Station 15+52. Roadside Ditches Will
® Yes ❑ No
Not Enter The Buffers From Station 18+00 To Station 20+00.The Roadside Ditches
Will Sheet Flow Through Vegetated Uplands Before Entering Into The Buffers. The
Proposed Cross -Line At Station 17+40 Will Take Stormwater From The Left Side
Of -L- To The Right Side Of -L- During Storm Events. The Proposed Driveway
Pipes At Station 17+00 Lt. And Rt.-L- Will Be Have Wattles To Treat Stormwater
Before Entering Into Broomfield Swamp Creek.
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
N/A Roadway/Bridge Project %
2b.
Does this project require a Stormwater Management Plan?
® Yes ❑ No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why:
2d.
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
Diffuse Flow Through Vegetation and Special Sediment Control Fences at Sta. 14+03.22' Rt.; Sta. 14+85, 29' Lt.;and
Sta.18+70, 26'Lt. An Outlet Energy Dissipator will be used at Station 15+15,29' Lt. Silt Fence will be used to contain
sediment on the project as shown on the plan sheet.
❑ Certified Local Government
2e.
Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
® DWQ 401 Unit
3.
Certified Local Government Stormwater Review
3a.
In which local government's jurisdiction is this project?
N/A
❑ Phase II
❑ NSW
3b.
Which of the following locally -implemented stormwater management programs
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other: N/A
3c. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ® No
attached?
4.
DWQ Stormwater Program Review
® Coastal counties
❑ HQW
4a.
Which of the following state -implemented stormwater management programs apply
❑ ORW
(check all that apply):
❑ Session Law 2006-246
® Other: NPDES Permit
4b.
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ® No
Page 8 of 10
PCN Form —Version 1.3 December 10, 2008 Version

■ 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
n/1 ❑ Agent
Received by (Printed Name) of Delivery
Is delivery address different from item V? Yes
If YES, enter delivery address below: ❑ No
M LC/e es
�. -ThNso
.gc X ¢3a a. Servi Type
/ Certified Mail ❑ Express Mail
©�/ ✓= /1�%Q [ /V C— -7 ❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
O 4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(transfer from service label) 7 010 1870 0001 0069 5766
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

UNITED STATES POSTAL SERVICE First -Class Mail
Postage & Fees Paid
98 it z 10
AR
I
• Sender: Please print your name, address, and ZIP44 ' this �
N.C. Dept. of Transportation
PO Box 1587
Greenville, NC 27835
r
IFAM Licc
11

■ Complete items 1, 2, and 3. Also complete A. Signa pre
item 4 if Restricted Delivery is desired. X ❑ Agent
■ Print your name and address on the reverse ❑ Addre
so that we Can return the Card to you. B, eceived by (Printed Name) C. Date of Deli
■ Attach this card to the back of the mailpiece,
or on the front if space permits. - t
1. Article Addressed to:
W�y£�%AUScK CpC
�PEco �s
1/d�c�b o,ea , NL 2 85 a [,
D. Is delivery address different from item 1? ❑ Ye:
If YES, enter delivery address below: ❑ No
3. Ice Type
)aNCertifled Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ yes
2. Article Number
(transfer from service label) 7 010 1870 0001 0069 5742
PS Form 3811, February 2004 Domestic Return Receipt
102595.02-M-1540

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
❑ Yes ® No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c.
6d.
6e.
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
None
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
N/A
6h. Comments:
Page 7 of 10
PCN Form — Version 1.3 December 10, 2008 Version

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
N.C. Dept. of Transportation
PO Box 1587
Greenville, NC 27835
7

■ 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:
M4CW-k1 p Al MdN f & kS
Ayu)oo4( K/RU/-','j
a1�r6k, n/C z7(P)3
A. Signatur C �' V
❑ Agent
gent
❑ Addressee
B. Rec i ed by ( Pn-nte Na e) C. Date of Delivery
(LI
D. Is delivery address different from item 1 ? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
]-'<-.rtified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
11 Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) 0 Yes
2. Article Number
(Transfer from service label) 7010 1870 0001 0069 5759
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

NC 30 OVER UNNAMED PITT COUNTY \
TRIB UTAR Y OF GRINDLE CREEK
PIPE REPLACEMENT
ROBERSOAWLLE, WEST USGS QUAD MAP cem
SHEET NUMBER 6-B
�3a W E ,
OF THE SOIL SURVEY OFPITT COUNTY
0
d s
PIPE REPLACEMENT
Y= 744801.7702
(�n3oJ 20'l X= 2483698.2239
N35^-47'-08►'
:y W 77^-22'--09 ►►
N 35.785526 DEGREES
—r—. W 77.369040 DEGREES
FIRM PANEL 4784
t6� MAP NUMBER 3720478400J .
cem
11 ci, 4
m
� O ' •° zaa
l I rs.Pvl'IBM o
4 1
1 rao
1421
1471
_.
1 inch = 2,000 feet I
0 750 1,500 3,000 4,500 6,000
Feet
i

]RECEIVED
� k
Office Use Only:
Corps action ID no. APR 6 201
F DWQ project no.
Form Version 1.3 Dec 1�� 0
fuwsek,,.xFJ
Pre -Construction Notification PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps:
® Section 404 Permit El Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? i ❑ Yes No i
1 d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express Riparian Buffer Authorization
le. Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes ® No
For the record only for Corps Permit:
❑ Yes No
1 f. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in4eu
fee program.
Yes ® No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
® Yes ❑ No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
I N Yes ❑ No
2. Project Information
2a. Name of project:
Pamlico NI-2028 SR 1324, Florence Road Over Richardson Creek
WBS Element Number 2B.206911
2b. County:
Pamlico
2c. Nearest municipality / town:
Oriental
2d. Subdivision name:
N/A
2e. NCDOT onty, T.I.P. or state
project no:
26 206911
3. Owner Information
3a. Name(s) on Recorded Deed:
North Carolina Department of Transportation
3b. Deed Book and Page No.
NIA
3c. Responsible Party (for LLC if
applicable):
N/A
3d. Street address:
105 Pactoius Highway NC 33 P.O. Box 1587
3e. City, state, zip:
Greenvale, NC 27835
3f. Telephone no.:
252-830-3490
3g. Fax no.:
252-830-3341
3h. Email address:
jbjohnsonCncdot.gov
Page l of 10
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ® Other, specify: Division 2 Environmental Officer
4b. Name:
Jay B. Johnson —
4c. Business name
(if applicable):
North Carolina Depratment of Transportation
4d. Street address:
P.O. Box 1587
4e. City, state, zip:
Greenville, NC 27835
4f. Telephone no.:
252-830-3490
4g. Fax no.:
252-830-3341
4h. Email address:
[e-mail]
S. Agent/Consultant information (if applicable)
5a. Name:
N/A
5b. Business name
(f applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 10
PCN Form — Version 1.3 December 10, 2008 Version

RECEIVED
APR 6 2011
B. Project Information and Prior Project History
- 1. Property Identification
NI-2028 SR 1325, Brown Creek Road Over U(T Brown
1 a. Property identification no. (tax PIN or parcel ID):
Creek
Latitude: N 35.114589 Longitude: - W
1 b. Site coordinates (in decimal degrees):
76.632187
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size:
N/A acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
UIT Brown Creek, a Tributary of Broad Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
SA;HQW;NSW
2c. River basin:
Neuse Lower Neuse 03020204
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
SR 1325, Brown Creek Road is a paved secondary state highway. Woodlands and Agriculture dominate the landscape.
3b. List the total estimated acreage of all existing wetlands on the property:
144 Square Feet (0.003 Acres) of Coastal Wetland Impacts For The Pipe To Pipe Replacement.
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
60' This site is part of a longer adjacent stream system
3d. Explain the purpose of the proposed project:
Pipe To Pipe Replacement; the existing pipe has deteoriated and needs replacing.
3e. Describe the overall project in detail, including the type of equipment to be used:
The Existing 72 Inch x 40 Feet Long CMP will be replaced with a Proposed 73 Inch x 53 Inch x 40 Feet Long CAAPA.
Excavators, Dump Trucks,and Crane Trucks will be used for the Pipe To Pipe Replacement_
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
Yes ®No Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
❑ Preliminary [I Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency/Consultant Company:
Name (if known): Stephen Lane
Other: NCDCM
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
August,2010
5. Project History
5a. Have permits or certifications been requested or obtained for
El Yes ®No El Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
® Wetlands ® Streams - tributaries ® Buffers
® Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non-404, other)
(acres)
Temporary
W1 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
0 Sq. Ft.
W2 ❑ P ❑ T
t
❑ Yes
❑ No
❑ Corps
❑ DWQ
0 Sq. Ft
W3 [] P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
OSq. Ft.
W4 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
0 Sq. Ft.
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps —
❑ No
❑ DWQ
2g. Total wetland impacts
0 Sq. Ft.
2h. Comments: No 404 Wetland Impacts 144 Sq. ft.(0.03 Acres) Coastal Impacts
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non-404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ®P ❑ T
Pipe
U(T Brown Creek
® PER
❑ INT
❑ Corps
® DWQ
20,
51
S2 ®P ❑ T
Pipe
U/T Brown Creek
® PER
❑ INT
❑ Corps
® DWQ
20'
5'
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
35 ❑ P ❑ T
❑ PER
❑ INT
❑ Corps
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
311, Total stream and
tributary impacts
i0 t.F
3i. Comments: 10 Linear Feet of Stream Impacts
Page 4 of 10
PCN Form — Version 1.3 December 10, 2008 Version

APR 6 2011
4. Open Water Impacts DC1W-MHD Ciry
It there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a.
4b,
4c.
4d.
4e.
Open water
Name of waterbody
impact number —
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary
01 ®P ❑ T
U!T Brown Creek
Fill
Tributary
45 Sq. Ft.
02 ®P ❑ T
U/T Brown Creek
Fill
Tnbutary
---
33 Sq. Ft.
03 ❑P❑T
04 ❑P❑T
41'. Total open water impacts
78 Sq. Ft.
4g. Comments: 78 Square Feet of Open Water Impacts
5. Pond or I_ake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
5b.
5c.
5d.
5e.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
acres
number
of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5t: Total
None
5g. Comments: None
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list ail buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a.
® Neuse ❑Tar -Pamlico ❑Other:
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b.
6c-
6d.
6e.
6f.
69-
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary )
impact
required?
B1 ®P ❑ T
Rip
Rap
U/T BrownCreek
❑ Yes
ElNo
86 Sq. Ft.
0 Sq. Ft.
B2 ®P ❑ T
R P
U/T Brown Creek
No
0 e
40 Sq. Ft.
0 Sq. Ft.
B3 ®P ❑ T
R P
U/T Brown Creek
El No
40 Sq. Ft.
-1
OSq. Ft.
6h. Total buffer impacts
6i. Comments: See Page 6-A For Totals
Page 5 of 10
PCN Form — Version 1.3 December 10, 2008 Version

4. Open Water Impacts
the Atlantic Ocean,
It there are proposed impacts to takes, ponds, estuaries, tributaries, sounds, or any other open water of
the U.S. then individually list all open water impacts below.
4a.
4b.
4c.
4d.
4e.
Open water
Name of waterbody
impact number —
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P❑T
--—
u
03 ❑ P ❑ T
04 ❑P❑T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
5b.
5c.
5d.
5e.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
I Filled
Excavated
Flooded
Filled
Excavated
Flooded
_P1 .
P2
5L Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5i. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a.
® Neuse El Tar -Pamlico ❑ Other: None
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Tempo a(T)
impact
required?
B1 ®P ❑ T
B4 Fill
U/T Brown Creek
® Nos
40 Sq. Ft.
0 Sq. Ft.
82 ❑ P ❑ T
❑ Yes
❑ No
El Yes
B3 ❑P❑T
❑ No
6h. Total buffer impacts
160 Sq. Ft.
0 Sq. Ft.
6i. Comments: 160 Square Feet of Buffer Zone 1 Impacts and 0 Sq. Ft. of Buffer Zone 2 Impacts
Page 5c of 10
PCN Form — Version 1.3 December 10, 2008 Version

APR 6 2011
crrx
D. impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
There are No 404 Wetland Impacts for this Project; However, There are 144 Square Feet (0.003 Acres) of Coastal Impacts, 78
Sq. ft. of Open Water Impacts, and 10 Linear Feet of Stream Impacts due to the installation of a proposed pipe to replace the
existing pipe. The Wetland Impacts have been minimized to the greatest extent feasible.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Use of existing roadway to operate construction equipment; no equipment will enter wetlands.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
❑ Yes ® No
2b. If yes, mitigation is requirkA by (check all that apply):
2c. If yes, which mitigation option will be used for this
project?
❑ DWQ ❑ Corps
❑ Mitigation bank
❑Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
3c. Comments:
4. Complete if Making a Payment to In4ieu Fee Pnogiarn
4a. Approval letter from in -lieu fee program is attached.
❑ Yes
4b. Stream mitigation requested:
linear feet
4c. If using stream mitigation, stream temperature:
❑ warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
acres
4f. Non -riparian wetland mitigation requested:
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
4h. Comments:
S. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
i
Page 6 of 10
PCN Form — Version 1.3 December 10, 2008 Version

S. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a_ Will the project result in an impact within a protected riparian buffer that requires
❑ Yes ® No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6C.
6d.
6e.
Zone
Reason for impact
Total impact
Multiplier
Required mitigation I4
(square feet)
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
None
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-tieu fee fund).
NIA
6h. Comments:
Page 7 of 10
PCN Form — Version 1.3 December 10, 2008 Version

RECEIVED
n nn41
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan DCM-MHD CITY
1 a. Does the project include or is it adjacent to protected riparian buffers identified
® Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments: Storm Water will diffuse flow through vegetated uplands before entering
® Yes ❑ No
wetlands. Silt Fences and Turbidity Curtains will be used to contain sediment and
turbidity in U/T Brown Creek.
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
NIA Roadway/Bridge Project %
2b. Does this project require a Stormwater Management Plan?
® Yes ❑ No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why-
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
The Project will diffuse flow through vegetated uplands before entering wetlands_ Silt Fences and Turbidity Curtains will
be used to contain sediment and turbidity in UIT Brown Creek.
❑ Certified local Government
2e. Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
® DWQ 401 Unit
3. Certiified Local Government Stormwater Review
3a. In which local governments jurisdiction is this project?
NIA
❑ Phase 11
3b. Which of the following locally -implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other: WA
3c. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ® No
attached?
4. DWQ Stormwater Program Review
® Coastal counties
® HQW
4a. Which of the following state -implemented stormwater management programs apply
❑ ORW
(check all that apply):
❑ Session Law 2006-246
® Other: NPDES Permit
4b. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ® No
attached?
S. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 8 of 10
PCN Form — Version 1.3 December 10, 2008 Version

FF- Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federaVstate/local) funds or the
® Yes ❑ No
use of public (federal/state) land?
1 b. if you answered `yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered `yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
❑ Yes ❑ No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after -the -fact permit application?
❑ Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
❑ Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered 'yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
N/A
Page 9 of 10
PCN Form — Version 1.3 December 10, 2008 Version

RECEP4ED
APR 6 2011
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
ACM-MHD CI'rX
5a. Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
❑ Yes No
impacts?
❑ Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NCDCM
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NCDCM
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
Not Applicable
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?
® Yes ❑ No
8b. If yes, explain how project meets FEMA requirements: Pipe designed to no -rise standards
8c. What source(s) did you use to make the floodplain determination? FEMA FIRM Maps
Jay B. Johnson
_�
March 31, 2011
Applicant/Agent's Printed Name
Date
/Ais nature
k�nrtiftoatAhorttion
(Agent's signature is id letter from the applicant
isprovided.)
Page 10 of 10
PCN Form — Version 1.3 December 10, 2008 Version

/'
Lane, Stephen
From:
Hart, Kevin
Sent:
Thursday, April 21, 2011 9:56 AM
To:
Lane, Stephen
Cc:
Deaton, Anne; West, Katy
Subject:
RE: Google Earth Image
Stephen,
The NCDMF requests that the DOT utilizes turbidity curtains up and downstream of the culvert
to minimize the adverse impacts from the elevated turbidity. We also request that NCDOT makes
all attempts to perform the work outside of the April 1 to July 30 moratorium to minimize the
impacts to juvenile fish in the area.
If you have any questions let me know.
Kevin
-----Original Message -----
From: Lane, Stephen
Sent: Monday, April 18, 2011 3:10 PM
To: Hart, Kevin
Subject: Google Earth Image
Hi Kevin,
The culvert over the UT to Brown Creek is located at : 35 degrees 6 minutes 52 seconds
North
76 degrees 37 minutes 56 seconds
West
The culvert over Richardson Creek which is a tributary to Spring Creek is located at : 35
degrees 7 minutes 43 seconds North
76
degrees 37 minutes 15 seconds West
Hope this helps and please let me know if you need further information.
Thanks,
Stephen
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1