56369_NC DOT_20110302

❑ CAMA / []DREDGE &FILL OVO ^ //
GENERAL PERMIT Previous permit #
❑New ❑Modification El Complete Reissue El Partial Reissue /L- Date previous permit issued
As aLthorized 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 I SA NCAC
❑ Rules attached.
Applicant Name Project Location: County
Address
City State ZIP
Phone # O Fax # ( )
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA
AEC(s): ❑ OEA ❑ HHF ❑ IH
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
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
4
t (Scale: )
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
c
I
I
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
t .,
A building permit may be required by: ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
PermitOfficer's Signature
Issuing Date Expiration Date
F '
Application Fee(s) Check # Local Planning Jurisdiction
Rover File Name

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowners).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar- Pamlico River Basin Buffer Rules ❑ Other:
❑ Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Morehead City Headquarters
Mailing Address:
400 Commerce Ave
1638 Mail Service Center
Morehead City, NC 28557
Raleigh, NC 27699-1638
252-808-2808/ 1-888ARCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
Fax:[phone]
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

LAMA / 1:1 DREDGE & FILL N° 56369
,',ENERAL PERMIT Previous permit #
DdNew LIModification Ll 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 I 5A NCAC
[EMules attached.
Applicant Name Project Location: County
Address 113
Street Address/ State Road/ Lot #(s)
�i- City L-d e-, I-Q A State ZIP '7
Phone # '7 eil 7
Fax # Subdivision
'-79 S3
Authorized Agent City ZIP) -
[I Cw Ll EW L4TA DES ROTS Phone# River Basin tkll
Affected Ll OEA D HHIF 0 1H EJ UBA 0 N/A
AEC(s): Adj. Wtr. Body C-PI f"' (6@/man Junkn)
11 PWS: Ll FC:
ORW: yes PNA yes/ no Crit.Hab. yes no Closest Maj. Wtr. Body
mill
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
-,#-400 4-F)-c13-3-ST.1 _
Application Fee(s) Check #
Permit Officer's Signature No
(-
Issuing Date Expiraqio
Y40 0 x qe
ir
Local Plan ningJ urisd iction Rover File Name

NC®ENR.
North Carolina Department of Environment and Natural
Division of Coastal Management
Beverly Eaves Perdue, Governor
March 4, 2011
Clay Willis
NC DOT
113 Airport Dr., Suite 100
Edenton, NC 27932
Dear Mr. Willis:
James H. Gregson, Director
Resources
Dee Freeman, Secretary
Attached is General Permit #56369C to relocate approximately 300' of 8" HDPE water line
under Connarista Swamp by directional bore, in Windsor NC.
In order to validate this permit, please sign the permit as indicated. Retain the white copy for
your files and return the signed yellow and pink copies to us in the enclosed, self-addressed
envelope. If the signed permit copies are not returned to this office before the initiation of
development, you will be working without authorization and will be subject to a Notice of
Violation and subsequent civil penalties.
We appreciate your early attention to this matter.
Sincerely,
Stephen Lane
Coastal Management Representative
lsb
Enclosures
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagement.net
An Equal Opportunity \ Affirmative Action Employer - 50% Recycled \ 10% Post Consumer Paper

---Z -----
Aaplicant:
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
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)amount
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
IJ�r,
Dredge ❑ Fill ❑ Both ❑ Other �
a o D
0
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-a02-20 .. I •v l8 };'*�'COAST .. -.q , .....,.v..m-+ —'A—A' a,z

�......� FEB 15 2011
STATE of NO[z n t CAROLiNA
DEPARTMENT OF TRANSPORTATION
Beverly F. Purdue Gene Conti
Govi RNO R SIfcRETARY
February 1-4, 201 1
Stephen Lane
Division of Coastal Management
400 Commerce Avenue
Morehead City. NC 28557
Dear Mr. L_£lne,
The NC DOT request the issuance ofa General Permit # 16 for the relocation of a
county waterline in association with the replacement of bridge # 36 in Bertie County. The
bridge is located on SR 1221 (Charles Taylor Rd.) approximately 1.25 miles west of the
intersection of NC 305 and SR 1221. The bridge spans Connarista Swamp, which is a
tributary that flows to the Cashie River approximately 0.6 miles downstream. The
Division of Water Quality cla:,sifies Connanste. Swamp as Class "C", "SW" waters,
which is also desi;Tnated an arladromous fish spawning area by the Wildlife Resource
Commission. The waterline will be directional bored under Connarista Swamp as shown
on the attached drawings. '['he boring will go From high ground to high ground and will
not result in any impacts to jurisdictional xiaters or wetlands. The waterline boring will be
approximately 300 feet in length and 6 feet in depth below the creek bed. The adjacent
landowners have been notified through email and phone conversation, x\hich took place
on 2/14/201 1. NCDOT is also mailing adjacent landowner lbrms certified mail. These
receipts will be forwarded 10 ou, as soon as they are received.
Included \V1th this letter are the MP Forms, adjacent landowner notice letters, and
permit dra-vvings. 11 you hays Liuestions please do not hesitate to call me at (252) 482-
7977.
Sincerely,
.Icrry Jennings. P.E.
.\sting Division Engineer, Division One
Clay Willis
I-.nvironmental l)f-cer, Division One
113 Airport Dr.. Suite 100. F(h.-rton, NC 279 "hone: (252) - 91-7977 Fax: (2s2) 482-8722

BCM MP-1
APPLICATION for
Major Development Permit FFR
(last revised 12/27/06)
M'F V(110rid Q„ nMp
North Carolina DIVISION OF COASt�!- MANAGEMENT
1. Primary Applicant/ Landowner Information
Project Name (if applicable)
Business Name
Bridge # 36 over Connarista Swamp
on SR 1221 (Charles
Ncdot Division One
Taylor Road) , Bertie County
ARRA-Stimulus Project
Applicant 1: First Name
MI
Last Name
Clay
Willis
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
113 Airport Drive Suite 100
1
Edenton
NC
ZIP
Country
Phone No.
FAX No.
27932
us
252 - 482 - 7977 ext. 221
252 - 482 - 8722
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>
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Form DCM MP-1 .(Page 2 of 5)
APPLICATION for
Major Development Permit
3. Project Location
County (can be multiple)
Street Address
State Rd. #
Bertie
SR 1221 (1.2 miles west of NC 305)
SR _
Subdivision Name
City
State
Zip
N/A
N/A
NC
27946 FEB
Phone No.
Lot No.(s) (if many, attach additional page with list)
- - ext.
a. In which NC river basin is the project located?
T. Name of body of water nearest to proposed project
Roanoke River Basin
Connarista Swamp
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
Cashie River
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.)
140 ft.
48000
c.
Size of individual lot(s)
d. Approximate elevation of tract above NHW (normal high water) or
NWL (normal water level)
n/a, I I
(If many lot sizes, please attach additional page with a list)
8-10 ft. ❑NHW or ®NWL
e.
Vegetation on tract
Bottomland hardwood swamp with many mature trees, which include Laurel Oaks, Swamp Chestnut Oaks, Swamp Black
Gum, Bald Cyprus. This community is on both sides of the roadway approaching the bridge. There are no coastal wetland
species on the project site.
f.
Man-made features and uses now on tract
SR 1221 and Bridge # 36
g.
Identify and describe the existing land uses adjacent to the proposed project site.
Primary land use within the project area consist of woodland and agriculture.
In.
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.
Has a professional archaeological assessment been done for the tract? If yes, attach a copy. ❑Yes ®No ❑NA
If yes, by whom?
I.
Is the proposed project located in a National Registered Historic District or does it involve a ❑Yes ®No ❑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)
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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.
4
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/Comm unity
b.
Give a brief description of purpose, use, and daily operations of the project when complete.
Relocate 500 feet of 8 in. HDPE county water line
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 waterline will be relocated using boring techniques that will locate the line 6 feet below the stream bed and along the
road shoulder as shown on the attached drawings. A boring machine and backhoe will be used to move the waterline.
d.
List all development activities you propose.
Relocate an existing 8" Bertie County water line by directional boring as depicted on the attached drawings.
e.
Are the proposed activities maintenance of an existing project, new work, or both? maintenance of an existing waterline
f.
What is the approximate total disturbed land area resulting from the proposed project? 1500 ®Sq.Ft or ❑Acres
g.
Will the proposed project encroach on any public easement, public accessway or other area ❑Yes ®No ❑NA
that the public has established use of?
h.
Describe location and type of existing and proposed discharges to waters of the state.
There are no proposed discharges into waters of the state associated with this waterline relocation.
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
I.
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 5 2 - 8 0 8 - 2 8 0 8 .. 9-888-4RCOAST .. www.nccoastalmanagement.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 Bertie County
Phone No.
Address P.O. Box 530
Windsor, N.C. 27983 MWWACKYBf I
Name Timberlands Unlimited, Inc.
Phone No.
Address P.O. Box 740
Windsor, N.C. 27983
Name Ralph Tayloe
Phone No.
Address 200 Homestead Road
Franklin, Virginia 23851
g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, permittee, and issuing dates.
NW 3 permit from the COE
CAMA GP 23 for bridge replacement # 36
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 i for ation provided in this application is truthful to a best of my knowledge.
Date Print Name 6114t ' l
Signature A 6
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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
252-808-2808 . 1-888-4RCOA aT .. www.nccoastalrrranageenent.net

Form I[IIIRS
ee�enee....w nm ueorc
RIDGES and
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of the Joint�'n
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/Comm unity Connarista Swamp, which is a tributary to the Cashie River
c. Type of bridge (construction material):
3 span cored slab concrete bridge
e. (i) Will proposed bridge replace an existing bridge? ®Yes ❑No
If yes,
(ii) Length of existing bridge: 70 ft.
(iii) Width of existing bridge: 25 ft.
(iv) Navigation clearance underneath existing bridge: 6 ft,
(v) Will all, or a part of, the existing bridge be removed?
(Explain) All of the existing bridge will be removed
and replaced with a new structure
g. Length of proposed bridge: 105 ft.
I. Will the proposed bridge affect existing water flow? ®Yes []No
If yes, explain: The new bridge is longer, which increase the
ability of the floodplain to function during flooding
events.
k. Navigation clearance underneath proposed bridge: 6.5 ft.
m. Will the proposed bridge cross wetlands containing no navigable
waters? ❑Yes ®No
If yes, explain:
d. Water depth at the proposed crossing at NLW or NWL:
2-3 feet
f. (i) Will proposed bridge replace an existing culvert? []Yes ®No
If yes,
(ii) Length of existing culvert: n/a
(iii) Width of existing culvert: n/a
(iv) Height of the top of the existing culvert above the NHW or
NWL: n/a
(v) Will all, or a part of, the existing culvert be removed?
(Explain) n/a
h. Width of proposed bridge: 30 ft.
j. Will the proposed bridge affect navigation by reducing or
increasing the existing navigable opening? ❑Yes ®No
If yes, explain: The new bridge will stay within 1 ft. of the
existing clearance.
I. Have you contacted the U.S. Coast Guard concerning their
approval? ❑Yes ®No
If yes, explain: n/a
n. Height of proposed bridge above wetlands: n/a
2. CULVERTS ®This section not applicable
a. Number of culverts proposed: n/a b. Water body in which the culvert is to be placed:
< Form continues on ll
c. Type of culvert (construction material):
252-808-2808 1-688-4RCOAST :: www.nccoastaimanageM!pr!3;.gaet revised: 10/26106
—._

m e (Bridges are owe s, �� � �� �}
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:
h. Height of the top of the proposed culvert above the NHW or NWL
j. Will the proposed culvert affect navigation by reducing or
increasing the existing navigable opening? ❑Yes ❑No
If yes, explain:
SCE"m,
FEB w 5 201,
e, (i) Will proposed culvert replace an existing culvert?
❑Yej,-;N,o
1} l►'
If yes,
(ii) Length of existing culvert(s):
(iii) Width of existing culvert(s):
(iv) Height of the top of the existing culvert above the NHW or
NWL:
(v) Will all, or a part of, the existing culvert be removed?
(Explain)
g. Width of proposed culvert:
i. Depth of culvert to be buried below existing bottom contour.
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. (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: feet affected.
(iii) Avg. width of area to be excavated: ❑CW ❑SAV ❑SB
(iv) Avg. depth of area to be excavated: OWL ®None
(v) Amount of material to be excavated in cubic yards:
(ii) Describe the purpose of the excavation in these areas:
n/a
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: 15'
(iv) Avg. depth of area to be excavated: 55=6
(v) Amount of material to be excavated in cubic yards: 122
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Form DCM MP- (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: approved NCDOT waste site
(ii) Dimensions of the spoil disposal area: To be determined waste sites will be NCDOT approved with reclamation plans
(iii) Do you claim title to the disposal area? ❑Yes [:]No (If no, attach a lettergranting 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:
(iii) Avg. width of area to be filled:
(iv) Purpose of fill:
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: 400
(iii) Avg. width of area to be filled: 50
(iv) Purpose of fill: roadway approaches, shoulder
reconstruction
4. GENERAL
a. Will the proposed project require the relocation of any existing b
utility lines? ®Yes ❑No
If yes, explain: 8 " waterline will be directional bored
under Connarista Creek as depicted on the attached
drawings. No impacts to jurisdictional features will result
from this waterline relocation.
If this portion of the proposed project has already received
approval from local authorities, please attach a copy of the
approval or certification.
(i) Will the placement of the proposed bridge or culvert result in any
fill (other than excavated material described in Item d above) to
be placed within coastal wetlands/marsh (CW), submerged
aquatic vegetation (SAV), shell bottom (SB), or other wetlands
(WL)? If any boxes are checked, provide the number of square
feet affected.
❑CW ❑SAV ❑SB
OWL 447 so. ft. []None
(ii) Describe the purpose of the excavation in these areas:
The shoulders on the roadway approaches are being
widened to accommodate the new bridge width.
Will the proposed project require the construction of any temporary
detour structures? ❑Yes ®No
If yes, explain:
< Form continues on back>
c. Will the proposed project require any work channels? d. How will excavated or fill material be kept on site and erosion
❑Yes ®No controlled?
252-808-2808 :: 1-866-4RCOAST :: uvwenr.r�ccaa >f:,8_raa n etases .raeE revs .ed: 10/26/06

Famm DUA F d- ' r�dlq;es and- Culverts, Page 4 � Z.,
If yes, complete Form DCM-MP-2.
e. What type of construction equipment will be used (for example,
dragline, backhoe, or hydraulic dredge)?
crane, excavator, backhoe, dumptrucks
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
Project Name
�llll� Ap
plicant Name
—� P
plicant Signature
NCDOT BMP's & guidelines for Soil and Erosion Control
Will wetlands be crossed in transporting equipment to project site?
[]Yes to
If yes, explain steps that will be taken to avoij or m I"ize
environmental impacts.
52-8£48- $£ 3 :: t-% F3 BAST :: vruiow,_c cecz sia m eta ean@gLnet revised. 1iii2fatiktz

ADJACENT RIPARIAN LANDOWNER STATEMENT
( Bertie County: Waterline Relocation associated with bridge # 36 replacement.)
R 4lJ
1, _ , am an adjacent riparian property owner and am
aware of the North Carolina Department of 'Transportation's plans for the waterline °?
relocation associated with bridge replacement on SR 1221 Charles Taylor 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 1 13-229.
are attached.
I have objections to the project as presently proposed and my comments
Signature of Adjacent Landowner
Date:

'y
ADJACENT RIPARIAN LANDOWNER STATEMENT� �' ���
( Bertie County: Waterline Relocation associated with bridge # 36 replacement.)
am an adjacent riparian property owner and am
aware of the North Carol ins, Department of Transportation's plans for the waterline
relocation associated with bridge replacement on SR 1221 Charles Taylor Rd. I am
further aware that this work wilt occur in an Al C and therefore will require authorization
from the Division of Coastal Management in accordance with the Coastal Area
Management Act (LAMA).
I nave no oUjcuion to the project as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
ai e attache,,
I have objections to the project as presently proposed and my comments
algnature of Adjacent Landowner
Date:

ADJACENT �:�!�AWAN LANDOWNER STATEMENT
_ 481
( Bertie Courty: Water'i -ie Relocation associated with bridge # 36 replacement
am an adjacent riparian property owner and am ROP
aware of the North Caroline L::epartment of Irunsportation's plans for the waterline
relocation associated with bridge replacement on SR 1221 Charles Taylor 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).
1 lfave no ob ,--tion to the prccct as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
L,ce attached.
l have objec-ic ns to the project :as presently proposed and my comments
`.signature of Adjacent Landowner
ate:

FEB
2 2
ADJACENT RIPARIAN LANDOnLNM STATEMENT
( Bertie County: Waterline Relocation associated with bridge 4 36 replacement.)
1, 1-� 1 j�.� Lp�, am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the waterline
relocation associated with bridge replacement on SR 1221 Charles Taylor 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).
have no objection to the project as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
1 have objections to the project as presently proposed and my comments
are attached_
Signat e of djacent andowner
Date: --I —��

ADJACENTRIIPARIAN LANDOWNER STATEMENT
( Bertie County: Waterline Relocation associated with bridge # 36 replacement.)
I, 1 �(4 /,!m r''4�am an adjacent riparian property owner and am
i n1d e r IaaclS
aware of the North Carolina Department of 'Transportation's plans for the waterline
relocation associated with bridge replacement on SR 1221 Charles Taylor 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.
I have objections to the project as presently proposed and my comments
are attached. TiM h a ,I�, ,�.If •�v. t�'w, {-eJ, 7�hc .
Signature ofA jacent L o ner
Date: Zl 44-4&,An7 2-0 l(

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Article Addressed to:
Timber Lands Unlimited, Inc.
P.O. Box 740
Windsor, NC 27983
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PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

UNITED
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°
NCDEPTOFTRANSPORTATION `
DIVISION OFFICE
113AIRPORT DRIVE, SU/TE10O >
EDENTON NC 27932
COUR|ER:1U'51'U2
FEB 2���1Y
MorefiecACHYDCM
J/:j1`j

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item 4 if Restricted Delivery is desired.
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Bertie County I
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PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1e40

UNITED STATES, Q�
• Sender: Please print your name, address, and ZIP+4 'in this box •
NC DEPT OF TRANSPORTATIO
DIVISION OFFICE
113 AIRPORT DRIVE, SUITE jlQCK liC�
EDENTON, NC 27932
COURIER:10-51-02
FEB 2
..........!I?�...?Ei

1
COMPLETE
■ 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.
1 ■ Attach this card to the back of the maiipiece,
or on the front if space permits.
1. Article Addressed to:
Raiph'Tayloe
200 Homestead Rd.
Franklin, VA 23851
A. Signature
%L. t ttii a Addressee `
eceived by (Prin d Nga94 IJ C. Date of Deli ery l
l I \ 1r,�A
D. Is delivery address different from item 1
If YES, enter delivery address below:
3. Service Type
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Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2 Article Number 7009 2820 0003 3738 31,59
(transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 10259e-02-M-1540

"Jill UNITED STATES POST 9,'StAftIf;1;V�.';j;_' ..........
ATF
• 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 Aunt)
COURIER: 10-51-02
4 LB 2
Morehead M-10C."! I
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QTIFIFD MAILTI, RECEIF
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R' Bertie County `ISPS
gent
D^ P.O. Box 530
r� orP Windsor, NC 27983
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r'U Sen; Ralph Tayloe PS
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200 Homestead Rd. .-__-------
p Stre
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------------
City,

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Coverage
Nrovtoea)
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our website
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Lands
Unlimited, InP.O.
Box 7400
LSe,Timber
Windsor, NC
27983