57920_NC DOT_20110909

❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
Previous permit#
❑New ❑Modification ❑Complete Reissue
El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
Applicant Name
Project Location: County
Address
Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # O Fax # O
Subdivision
Authorized Agent `
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
Phone # () River Basin
AEC s : ❑ OEA ❑ HHF ❑ IH El USA ❑ N/A
Adj. Wtr. Body (nat /man /unkn?
❑ PWS: ❑FC:
ORW: es / no PNA
y yes / no Crit.Hab.
Closest Maj. Wtr. Body
yes / no
Type of Project/ Activity
Pier (dock) length
(Scale: )
Platform(s)
Finger piers)
Groin length
number
Bulkhead/ Riprap length
_
44
avg distance offshore
I
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
--
Other
I
Shoreline Length
SAV: not sure yes no
i
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
j
A building permit may be required by:
Notes/ Special Conditions
Q See note on back regarding River Basin rules.
Agent or Applicant Printed Name
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Issuing Date
Local F9anning Jurisdiction
Expiration Date
Rover File Name

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, 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/ 1-888-4RCOAST
Fax: [phone]
Location:
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
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

�0�
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue
Governor
September 22, 2011
NCDOT
c/o Clay Willis
113 Airport Dr., Suite 100
Edenton, N.C. 27932
Dear Mr. Willis:
Dee Freeman
Secretary
Attached is General Permit 457920 C to replace the existing 18" X 40' culvert at SR I I10, Engelhard, North
Carolina with a 24" X 40' culvert.
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, NC 28557
Phone: [phone] FAX: [phone] Internet: www,nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer
NorthCarolina
;Vaturallff

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
Stephen Lane
NC Division of Coastal Management
400 Commerce Ave.
Morehead City, NC 28557
Dear Mr. Lane,
EUGENE A. CONTI, JR.
SECRETARY
August 25, 2011
AUG 2 9 2011
t.
DcU-Aft Crrr
This letter is requesting a general permit .2300 be issued for a pipe replacement on SR 1110 Nebraska
Rd, 0.2 miles south of SR 1116 (Great Ditch Rd) in Hyde County. The current pipe is failing and needs to
be replaced to ensure safe public travel. The existing pipe (1 @ 40' x 18" CMP) will be replaced with the
proposed pipe (1 @ 40' x 24" CAP). Division of Coastal Management considers the project area to be
within an AEC that requires authorization for the pipe replacement. Included with this request are the MP-
1, MP-5 forms, location map, landowner notices, and permit drawings depicting the proposed work. The
WBS element # is 1.204811. If any additional information is needed please contact Clay Willis at 252-482-
7977.
Sincerely,
Jerry Jennings, P.E.
Division Engineer, Division One
{ Clay Willis
Environmental Officer, Division One
113 Airport Drive, Suite 100, Edenton, NC 27932, Phone [phone], Fax [phone]

ON MP-1
APPLICATION for
Major Development Permit
(last revised 12/27/06)
North Carolina DIVISION OF COASTAL MANAGEMENT
1. Primary Applicant Landowner Information
Business Name
N.C. Department Of Transportation
Project Name (if applicable)
SR 1110 Nebraska Rd Pipe Replacement
Applicant 1: First Name
Clay
MI
Last Name
Willis
Applicant 2: First Name
MI
Last Name
If additional applicants, please attach an additional page(s) with names listed.
Mailing Address
113 Airport Road, Suite 100
PO Box
City
Edenton
State
NC
ZIP
27932
Country
Phone No.
252 - 482 - 7977 ext.
FAX No.
252 - 482 - 8722
Street Address (if different from above)
City
State
ZIP
Email
2. AgentContractor 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
Major Development Permit
3. Project Location
County (can be multiple)
Street Address
State Rd. #
Hyde
SR 1110 Nebraska Rd, 0.2 mi. S. of SR 1116 (Great Ditch Rd)
SR 1110
Subdivision Name
City
State
Zip
Engelhard
I NC
27824 -
Phone No.
Lot No.(s) (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
Tar -Pamlico
Gray Ditch (excavated canal), trib. to Wysocking Bay
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
Pamlico Sound
e. Is proposed work within city limits or planning jurisdiction?
f. If applicable, list the planning jurisdiction or city limit the proposed
❑Yes ®No
work falls within.
n/a
4. Site Description
a. Total length of shoreline on the tract (ft.)
b. Size of entire tract (sq.ft.)
20'
1200
c. Size of individual lot(s)
d. Approximate elevation of tract above NHW (normal high water) or
NWL (normal water level)
(If many lot sizes, please attach additional page with a list)
1 ❑NHW or ®NWL
e. Vegetation on tract
Various roadside grasses on a maintained shoulder.
f. Man-made features and uses now on tract
SR 1110
g. Identify and describe the existing land uses adiacent to the proposed project site.
Rural residential and agricultural .
h. How does local government zone the tract?
i. Is the proposed project consistent with the applicable zoning?
N/A
(Attach zoning compliance certificate, if applicable)
❑Yes ❑No ®NA
j. Is the proposed activity part of an urban waterfront redevelopment proposal? ❑Yes ®No
k. Hasa professional archaeological assessment been done for the tract? If yes, attach a copy. ❑Yes ®No ❑NA
If yes, by whom?
I. Is the proposed project located in a National Registered Historic District or does it involve a ❑Yes ®No ❑NA
National Register listed or eligible property?
<Form continues on next page>
m. (i) Are there wetlands on the site? Yes ®No
(ii) Are there coastal wetlands on the site? ❑Yes ®No
(iii) If yes to either (i) or (ii) above, has a delineation been conducted? []Yes ®No
(Attach documentation, if available)
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' -4 nrn DCM MP-1 (Page 3 of 5)
APPLICATION for
Major Development Permit
n. Describe existing wastewater treatment facilities.
None
o. Describe existing drinking water supply source.
None
p. Describe existing storm water management or treatment systems.
None
5. Activities and Impacts
a. Will the project be for commercial, public, or private use? ❑Commercial ®Public/Government
❑Private/Community
b. Give a brief description of purpose, use, and daily operations of the project when complete.
The purpose of this project is to replace the existing pipe that is structuadly failing on SR 1110.
c. Describe the proposed construction methodology, types of construction equipment to be used during construction, the number of each type
of equipment and where it is to be stored.
Methods of construction will be concurrent with NCDOT Best Management Practices for the replacement of pipes. A
tracked excavator, backhoe, and dump truck will be used during construction.
d. List all development activities you propose.
Replace the existing pipe 1 @ 40' x 18" Corrugated Metal Pipe with 1 @ 40' x 24" Corrugated Aluminum Pipe.
e. Are the proposed activities maintenance of an existing project, new work, or both? Maintenance
f. What is the approximate total disturbed land area resulting from the proposed project? 144 ®Sq.Ft or ❑Acres
g. Will the proposed project encroach on any public easement, public accessway or other area ❑Yes ®No ❑NA
that the public has established use of?
h. Describe location and type of existing and proposed discharges to waters of the state.
Surface runoff from SR 1110.
I. Will wastewater or stormwater be discharged into a wetland? []Yes ®No ❑NA
If yes, will this discharged water be of the same salinity as the receiving water? ❑Yes ❑No ❑NA
j. Is there any mitigation proposed? ❑Yes ®No ❑NA
If yes, attach a mitigation proposal.
<Form continues on back>
6. Additional Information
In addition to this completed application form, (MP-1) the following items below, if applicable, must be submitted in order for the application
package to be complete. Items (a) — (1) 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.
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• Dorm 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 Benjamin Carawan
Phone No.
Address PO Box 172
Wanchese, NC 27981
Name Luverne Midgette
Phone No.
Address 3850 Station Rd
Creswell, NC 27928
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.
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 tha the information provided in this application is truthful to the best of my knowledge.
Date / Print Name _Clay Willis, Environmental Officer
Signature
Please indicate application attachments pertaining to your proposed project.
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:F8wn DCM MP-1 (Page 5 of 5)
APPLICATION for
Major Development Permit
❑DCM MP-2 Excavation and Fill Information ®DCM MP-5 Bridges and Culverts
❑DCM MP-3 Upland Development
❑DCM MP-4 Structures Information

Form DCM MP-5
BRIDGES and CULVERTS
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of the Joint
Application that relate to this proposed project. Please include all supplemental information.
1. BRIDGES ®This section not applicable
a. Is the proposed bridge: b. Water body to be crossed by bridge:
❑Commercial ❑Public/Government ❑Private/Community
c. Type of bridge (construction material):
e. (i) Will proposed bridge replace an existing bridge? ❑Yes ❑No
If yes,
(ii) Length of existing bridge:
(iii) Width of existing bridge:
(iv) Navigation clearance underneath existing bridge:
(v) Will all, or a part of, the existing bridge be removed?
(Explain)
9• Length of proposed bridge:
i. Will the proposed bridge affect existing water flow? ❑Yes ❑No
If yes, explain:
d. Water depth at the proposed crossing at NLW or NWL:
f. (i) Will proposed bridge replace an existing culvert? ❑Yes []No
If yes,
(ii) Length of existing culvert:
(iii) Width of existing culvert:
(iv) Height of the top of the existing culvert above the NHW or
NWL:
(v) Will all, or a part of, the existing culvert be removed?
(Explain)
h• Width of proposed bridge:
j. Will the proposed bridge affect navigation by reducing or
increasing the existing navigable opening? ❑Yes [-]No
If yes, explain:
k• Navigation clearance underneath proposed bridge: I. Have you contacted the U.S. Coast Guard concerning their
approval? ❑Yes ❑No
If yes, explain:
m. Will the proposed bridge cross wetlands containing no navigable n. Height of proposed bridge above wetlands:
waters? ❑Yes [-]No
If yes, explain:
2. CULVERTS ❑This section not applicable
a - Number of culverts proposed: 1 b. Water body in which the culvert is to be placed:
Pipe outlets into Gray Ditch, a tributary to Wysocking Bay.
< Form continues on back>
c. Type of culvert (construction material):
40' x 24" Corrugated Aluminum Pipe
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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.
6"'
j. Will the proposed culvert affect navigation by reducing or
increasing the existing navigable opening? ❑Yes ®No
If yes, explain:
e. (i) Will proposed culvert replace an existing culvert?
®Yes ❑No
If yes,
(ii) Length of existing culvert(s): 40'
(iii) Width of existing culvert(s): 18"
(iv) Height of the top of the existing culvert above the NHW or
NWL: 11"
(v) Will all, or a part of, the existing culvert be removed?
(Explain) All
9• Width of proposed culvert: 24"
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 ❑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 (SIB), or other wetlands
(ii)Av length of area to be excavated: 40' (WL)? If any boxes are checked, provide the number of square
9• 9 feet affected.
(iii) Avg. width of area to be excavated: 4' ❑CW ❑SAV ❑SB
(iv) Avg. depth of area to be excavated: 2' ❑WL ®None
(v) Amount of material to be excavated in cubic yards: 11.9
(ii) Describe the purpose of the excavation in these areas:
c. (i) Will the placement of the proposed bridge or culvert require any
high -ground excavation? ®Yes [:]No
If yes,
(ii) Avg. length of area to be excavated: 36'
(iii) Avg. width of area to be excavated: 4'
(iv) Avg. depth of area to be excavated: 2'
(v) Amount of material to be excavated in cubic yards: 10.7
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d. If the placement of the bridge or culvert involves any excavation, please complete the following:
(i) Location of the spoil disposal area: NCDOT approved waste area site.
(ii) Dimensions of the spoil disposal area: N/A
(iii) Do you claim title to the disposal area? ®Yes ❑No (If no, attach a letter granting permission from the owner.)
(iv) Will the disposal area be available for future maintenance? ®Yes ❑No
(v) Does the disposal area include any coastal wetlands/marsh (CW), submerged aquatic vegetation (SAVs), other wetlands (WL), or shell
bottom (SB)?
❑CW ❑SAV OWL ❑SB ®None
If any boxes are checked, give dimensions if different from (ii) above.
(vi) Does the disposal area include any area below the NHW or NWL? ? ❑Yes ®No
If yes, give dimensions if different from (ii) above.
e. (i) Will the placement of the proposed bridge or culvert result in any
fill (other than excavated material described in Item d above) to
be placed below NHW or NWL? ❑Yes ®No
If yes,
(ii) Avg. length of area to be filled:
(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
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
be placed 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.
❑CW ❑SAV ❑SB
❑WL ❑None
(ii) Describe the purpose of the excavation in these areas:
fill (other than excavated material described in Item d above) to
be placed on high -ground? ❑Yes ®No
If yes,
(ii) Avg. length of area to be filled:
(iii) Avg. width of area to be filled:
(iv) Purpose of fill:
4. GENERAL
a. Will the proposed project require the relocation of any existing b. Will the proposed project require the construction of any temporary
utility lines? ❑Yes jSINo detour structures? ❑Yes ®No
If yes, explain: If yes, explain:
If this portion of the proposed project has already received
approval from local authorities, please attach a copy of the
approval or certification.
< Form continues on back>
c. Will the proposed project require any work channels? d. How will excavated or fill material be kept on site and erosion
❑Yes ®No controlled?
If yes, complete Form DCM-MP-2. Using NCDOT best management practices for sediment
and erosion control.
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e. What type of construction equipment will be used (for example,
dragline, backhoe, or hydraulic dredge)?
tracked excavator, dumptruck, backhoe
g. Will the placement of the proposed bridge or culvert require any
shoreline stabilization? ®Yes ❑No
If yes, complete form MP-2, Section 3 for Shoreline
Stabilization only.
K0
Date
SR 1110 Nebraska Rd Pipe Replacment
Project Name
Clay Willis, Environmental Officer
plicant Name
plicant Signature
f. Will wetlands be crossed in transporting equipment to project site?
❑Yes ®No
If yes, explain steps that will be taken to avoid or minimize
environmental impacts.
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EXISTIN
PROPOSE
SR 1110
PLAN VIEW
DITCH
GRAY DITCH
(CANAL)
WYSOCKNG BAY
NWL
N
END VIEW
EXISTING 18' X 40' CMP
SR IIIO NEBRASKA RD
NWL
-STREAM BED
PROPOSED 24' X 40' CAP

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
August 15, 2011
Luverne Midgette
3850 Station Rd
Creswell, NC 27928
To Whom It May Concern:
EUGENE A. CONTI, JR.
SECRETARY
CERTIFIED MAIL
The NC Department of Transportation is proposing to replace a metal pipe on SR
1110 Nebraska Rd. The site is located approximately 0.2 miles south of the intersection
of SR11 16 (Great Ditch Rd). The existing pipe is 40' x 18" Corrugated Metal Pipe and
the proposed pipe is 40' x 24" Corrugated Aluminum Pipe. All work will be conducted
within NCDOT right-of-way.
The Division of Coastal Management (DCM) considers the adjacent waters to be
estuarine waters under their regulations. Therefore, it is provided protection under state
law. For this reason the NCDOT will apply for a permit from the DCM to perform the
described work. Part of the permit process is notifying the adjacent landowners of the
proposed work. A map depicting the project area, along with a design plat is included
with this letter. If you have any questions concerning the proposed work you can contact
Clay Willis at 252-482-7977.
113 Airport Drive, Suite 100, Edenton, NC 27932, Phone [phone], Fax [phone]

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

ADJACENT RIPARIAN LANDOWNER STATEMENT
(Hyde County: SR 1110, 0.2 miles south of SR 1116)
I, , am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the pipe
replacement on SR 1110. I am further aware that this work will occur in an AEC and
therefore will require authorization from the Division of Coastal Management in
accordance with the Coastal Area Management Act (CAMA).
I have no objection to the project as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
are attached.
I have objections to the project as presently proposed and my comments
Signature of Adjacent Landowner
Date:

s..+ STA7E •,
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
August 15, 2011
Benjamin Carawan
PO Box 172
Wanchese, NC 27981
To Whom It May Concern:
EUGENE A. CONTI, JR.
SECRETARY
CERTIFIED MAIL
The NC Department of Transportation is proposing to replace a metal pipe on SR
1 110 Nebraska Rd. The site is located approximately 0.2 miles south of the intersection
of SRI 116 (Great Ditch Rd). The existing pipe is 40' x 18" Corrugated Metal Pipe and
the proposed pipe is 40' x 24" Corrugated Aluminum Pipe. All work will be conducted
within NCDOT right-of-way.
The Division of Coastal Management (DCM) considers the adjacent waters to be
estuarine waters under their regulations. Therefore, it is provided protection under state
law. For this reason the NCDOT will apply for a permit from the DCM to perform the
described work. Part of the permit process is notifying the adjacent landowners of the
proposed work. A map depicting the project area, along with a design plat is included
with this letter. If you have any questions concerning the proposed work you can contact
Clay Willis at 252-482-7977.
113 Airport Drive, Suite 100, Edenton, NC 27932, Phone [phone], Fax [phone]

The attached form is submitted to insure that you have an opportunity to comment
on the proposal. The work is depicted on the attached drawings. If you have no objects to
the proposal, please return the form with your response within ten (10) days to this office.
If you do have objections to the project, please forward your comments to:
Stephen Lane
NC Division of Coastal Management
400 Commerce Ave
Morehead City, NC 28557
No response within ten (10) days will be construed to mean you have no objections.
Thank you for your cooperation.
Sincerely,
Jerry Jennings, P.E.
Division Engineer, Division One
Clay Willis , /,4
Environmental Officer, Division One

ADJACENT RIPARIAN LANDOWNER STATEMENT
(Hyde County: SR 1110, 0.2 miles south of SR 1116)
I, , am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the pipe
replacement on SR 1110. 1 am further aware that this work will occur in an AEC and
therefore will require authorization from the Division of Coastal Management in
accordance with the Coastal Area Management Act (LAMA).
I have no objection to the project as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
are attached.
I have objections to the project as presently proposed and my comments
Signature of Adjacent Landowner
Date:

�;oplicarC
Da[e: �r �--
Describe below the HABITAT disturbances for the application. All values should r-natch 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)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
/
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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 ❑
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1 ■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Lweme- h'\�3cA
�gsd 5 f0.-�lOn ��ac�
creSwe\\ I NC
A.
Agent
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Received by (Printed N me) C. Date of Delivery
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D. Is delivery address diffeWt from item 1? ❑ Yes
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2. Article Number -
(Transfer 2820 ooa3 3738 3739
(Transfer from service label) _
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

UNITED STATE'4�,,
FT 'J� jr
• Sender: Please print your name, address, and ZIP+4--ih this boX 0"
NC DEPT OF TRANSPORTATION
DIVISION OFFICE
113 AIRPORT DRIVE, SUITE 100
EDENTON, NC 27932
COURIER: 10-51-02
..........

•SECTION
.a items 1, 2, and 3. Also complete
ne. . . > if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can r'eturn the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Co f0'W an
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2. Article Number
(Transfer from service label)
PS Form 3811, February 2004
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D. Is delivery address different from item 1? P Ye:
If YES, enter delivery address below: ❑ No
3. S rvice Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
7009 2820 0003 3738 3746
Domestic Return Receipt
102595-02-M-1540

UNITED STATA3.
• Sender: Please print your name, address, and ZIP+4 in this box •
1:
NC DEPT OF TRANSPORTATION
DIVISION OFFICE
113 AIRPORT DRIVE, SUITE 100
EDENTON, NC 27932
COURIER: 10-51-02
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