58890_NC DOT_20111003

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Applicant Name
Address
City ' ` State ZIP' -
Phone # (. ' ) Fax #
Authorized Agent "" I
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
l► ,
Previous permit #
Date previous permit issued
❑ Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # O River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(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 Y f A
Shoreline Length
SAV: not sure yes no,
Sandbags: not sure yes no.
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A buildingpermit may be required
P Y 9
Notes/ Special Conditions
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❑ See note
on
back
regarding
8a
8
River
Basin
rules.
Agent or Applicant Printed Name _
J.
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
Local Planningjurisdiction 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
❑ Neuse River Basin Buffer Rules
❑ Other:
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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

ALT
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue
Governor
October 4, 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 #58890 C to construct a 16' 2" X 5' 1" X 63' 1" culvert to replace two existing
culverts and relocate a water line on NC 12, Buxton, 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, NC 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer
NorthCaroina
Nm ra!!rf

RECEIVED
OCT 0 3 2011
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION DCM-III•IA CITY
BEVERLY EAVES PERDUE
Go V ERNOR
October 3, 2011
Stephen Lane
NC Division of Coastal Management
400 Commerce Ave.
Morehead City, NC 28557
Dear Mr. Lane,
EUGENE A. CONTI, JR.
SECREl.4RY
This letter is requesting a general permit .1700 be issued for an emergency pipe replacement on NC
12, 0.06 miles southeast of SR 1233 (Light Plant Rd) in Dare County. The current pipes were damaged
during Hurricane Irene and are failing and need to be replaced to ensure safe public travel. The existing
pipes are 2 @ 60" x 68'-6" CMP and will be replaced with the proposed 1 @ 16'-2" x 5'-1" x 63'-1" ABC
with headwalls. The road shoulder at the inlet and outlet of the pipe will be stabilized with rip -rap. The
Division of Coastal Management considers the project area to be within an AEC that requires authorization
for the pipe replacement. Included with this request are the MP -I, MP-2, MP-5 forms, location map,
landowner notices, and permit drawings depicting the proposed work. The WBS element # is 1 B.102811.
If any additional information is needed please contact Ryan Shook 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]

EOM NP4
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)
NC 12 Pipe Replacement
Applicant 1: First Name
Ryan
MI
Last Name
Shook
Applicant 2: First Name
MI
Last Name
If additional applicants, please attach an additional page(s) with names listed.
Mailing Address
113 Airport Road
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)
Email
City State
ZIP
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
Slate
ZIP
Phone No. 1
-
- ext.
Phone No. 2
- - ext.
FAX No.
Contractor #
Street Address (if different from above)
Ciry
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. #
Dare
NC 12, 0.06 miles southeast of SR 1233 Light Plant Rd
NC 12
Subdivision Name
City
State
Zip
Buxton
NC
27920 -
Phone No.
Lot No.(s) (rf many, attach additional page with list)
- - ext.
a. In which NC river basin is the project located?
b. Name of body of water nearest to proposed project
Pasquotank
Unnamed trib. (canal) to Cape 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
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.
4. Site Description
a. Total length of shoreline on the tract (ft.)
b. Size of entire tract (sq.ft.)
70
4200
c, Size of individual lot(s)
d. Approximate elevation of tract above NHW (normal high water) or
NWL (normal water level)
(If many lot sizes, please attach additional page with a list)
2 ❑NHW or ®NWL
e. Vegetation on tract
At waters edge, spartina patens was present. Various roadside grasses on a maintained shoulder,
f. Man-made features and uses now on tract
NC 12
g. Identify and describe the existing land uses adiacent to the proposed project site.
A mix of commercial, residential, and vacant lots in the village of Buxton.
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? DYes NNo
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 ZNo NA
National Register listed or eligible property?
<Form continues on next page>
m. (i) Are there wetlands on the site? ®Yes ONo
(it) 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)
I- 8.38.'A re C() A's T. wov •';, g! �rr..xc i airnan:ac3r aiz%,i[.r;"4

Form DCM MP-1 (Page 3 of 5)
APPLICATION for
n. Describe existing wastewater treatment
None
o. Describe existing drinking water supply source.
None
p. Describe existing storm water management or treatment systems.
None
Major Development Permit
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 structurally failing on NC 12.
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 existing pipe 2 @ 60" x 68'-6" Corrugated Metal Pipes with 1 @ 16'-2" x 5'-1" x 63'-l" Aluminum Box Culvert with
aluminum headwalls and rip rap at the four corners of the pipe for shoulder stabilization. The waterline on the east side of
the project will be relocated. The line will be relocacted by open cut method while the project area is being dewatered and
will be installed in the dry.
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? 1200 ®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 NC 12.
I. Will wastewater or stormwater be discharged into a wetland? ❑Yes MNo EINA
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 IZINo UNA
If yes, attach a mitigation proposal.
<Form continues on backer
6. Additional Information
/n addition to this completed application form, (MP-1) the following items below, if applicable, must be submitted in order for the application
package to be complete. Items (a) — (0 are always applicable to any major development application. Please consult the application
instruction booklet on how to properly prepare the required items below.
a. A project narrative.
b. An accurate, dated work plat (including plan view and cross -sectional drawings) drawn to scale. Please give the present status of the
proposed project. Is any portion already complete? If previously authorized work, dearly 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.
t-853$1-4RCOABT wwvr.r,.:cu.is:t:31rn, gerr1�r.9

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 John F Conner, Jr
Phone No.
Address PO Box 71
Buxton, NC 27920
Name Scott Busbey
Phone No.
Address P.O. Box 333
Buxton, NC 27920
Name Clara Rollinson
Phone No.
Address 4331 Hollyshire Dr
Saint Louis, MO 63129
Name Shelly Rollinson
PO Box 351
Buxton, NC 27920
Name Diana Satterwhite
PO Box 1583
Buxton, NC 27920
Name Mikki Fuller
3804 Annie Ln
Virginia Beach, VA 23452
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.
1. Wetland delineation, if necessary.
j. A signed AEC hazard notice for projects in oceanfront and inlet areas. (Must be sty W by properly 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

Form DCM MP-1 (Page 5 of 5)
APPLICATION for
Major Development Permit
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.
1 further certify that the information provided in this application is truthful to the best of my knowledge.
Date (Gn/ / r' Print Name Ryan Shook, Environmental Specialist
Signature �-
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
N4*t`N.PSt,C(11A"-ii:)iil.:I v.="IP11 t_r)Rt

Form DCM MP-2
EXCAVATION and FILL
(Except for bridges and culverts)
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of the Joint
Application that relate to this proposed project. Please include all supplemental information.
Describe below the purpose of proposed excavation and/or fill activities. All values should be given in feet.
Access
Other
Channel
Canal
Boat Basin
Boat Ramp
Rock Groin
Rock
(excluding
(NLW or
Breakwater
shoreline
NWL)
stabilization)
Length
Width
- -
Avg. Existing
---
Depth
NA
NA
Final Project
Depth
N A
NA
9. EXCAVATION
a. Amount of material to be excavated from below NHW or NWL in
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:
®This section not applicable
b. Type of material to be excavated.
d. High -ground excavation in cubic yards.
2. DISPOSAL OF EXCAVATED MATERIAL ®This section not applicable
a. Location of disposal area. b. Dimensions of disposal area.
c. (i) Do you claim title to disposal area? d. (i) Will a disposal area be available for future maintenance?
[-]Yes ❑No DNA ❑Yes ❑No ❑NA
(ii) If no, attach a letter granting permission from the owner. (ii) If yes, where?
e. (i) Does the disposal area include any coastal wetlands/marsh
(CW), submerged aquatic vegetation (SAV), shell bottom (SB),
or other wetlands (WL)? If any boxes are checked, provide the
number of square feet affected.
❑CW ❑SAV ❑SB
OWL ❑None
(ii) Describe the purpose of disposal in these areas:
f. (i) Does the disposal include any area in the water?
❑Yes ❑No DNA
(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:
[]Bulkhead ORiprap ❑Breakwater/Sill []Other:
c. Average distance waterward of NHW or NWL: 3'
e. Type of stabilization material:
riprap
g. Number of square feet of fill to be placed below water level.
Bulkhead backfill Riprap 45
Breakwater/Sill Other
i. Source of fill material.
b. Length: 15'
Width: 8-9'
d. Maximum distance waterward of NHW or NWL: 3'
f. (i) Has there been shoreline erosion during preceding 12
months?
❑Yes ®No ❑NA
(ii) If yes, state amount of erosion and source of erosion amount
information.
h. Type of fill material.
riprap
4. OTHER FILL ACTIVITIES ®This section not applicable
(Excluding Shoreline Stabilization)
a. (i) Will fill material be brouqht to the site? ❑Yes ❑No ❑NA b. (i) Will fill material be placed in coastal wetlands/marsh (CW),
If yes,
(ii) Amount of material to be placed in the water
(iii) Dimensions of fill area
(iv) Purpose of fill
submerged aquatic vegetation (SAV), shell bottom (SB), or
other wetlands (WL)? If any boxes are checked, provide the
number of square feet affected.
❑CW ❑SAV ❑SB
❑WL ❑None
(ii) Describe the purpose of the fill in these areas:
5. GENERAL
a. How will excavated or fill material be kept on site and erosion b. What type of construction equipment will be used (e.g., dragline,
controlled? backhoe, or hydraulic dredge)?
Using NCDOT Best Management Practices for soil and erosion tracked excavator, backhoe, dumptnxk
control.
c. (i) Will navigational aids be required as a result of the project?
[]Yes ®No ❑NA
(ii) If yes, explain what type and how they will be implemented.
d. (i) Will wetlands be crossed in transporting equipment to project
site? []Yes ®No ❑NA
(ii) If yes, explain steps that will be taken to avoid or minimize
environmental impacts.
1 / j / Ryan Shook, Environmental Specialist
Date Applicant Name
NC 12 pipe replacement, 0.06 mi. SE of SR 1233
cant Signature
Project Name

Form UCM 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/Govemment ❑Private/Community
c. Type of bridge (construction material):
d. Water depth at the proposed crossing at NLW or NWL:
e. (i) Will proposed bridge replace an existing bridge? ❑Yes ❑No f.
If yes,
(ii) Length of existing bridge:
(iii) Width of existing bridge:
(iv) Navigation clearance underneath existing bridge:
(v) Will all, or a part of, the existing bridge be removed?
(Explain)
g. Length of proposed bridge:
I. Will the proposed bridge affect existing water flow?
If yes, explain:
(i) Will proposed bridge replace an existing culvert? ❑Yes ONO
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:
[]Yes ❑No 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 [I This section not applicable
a. Number of culverts proposed: 1 b. Water body in which the culvert is to be placed:
Unnamed tributary (canal) to Cape Creek.
< Form continues on back>
c. Type of culvert (construction material):
1-16'-2" x 5-1" x 63'-1" Aluminum Box Culvert with headwalls

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: 63'-1"
h. Height of the top of the proposed culvert above the NHW or NWL.
2.5'
j. Will the proposed culvert affect navigation by reducing or
increasing the existing navigable opening? ❑Yes ®No
If yes, explain:
3. EXCAVATION and FILL
a. (i) Will the placement of the proposed bridge or culvert require any
excavation below the NHW or NWL? ®Yes ❑No
If yes,
(ii) Avg. length of area to be excavated: 63'
(iii) Avg. width of area to be excavated: 20'
(iv) Avg. depth of area to be excavated: 2'
(v) Amount of material to be excavated in cubic yards: 93
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: 50'
(iii) Avg. width of area to be excavated: 20'
(iv) Avg. depth of area to be excavated: 2'
(v) Amount of material to be excavated in cubic yards: 37
e. (i) Will proposed culvert replace an existing culvert?
®Yes ❑No
If yes,
(ii) Length of existing culvert(s): 68'-6"
(iii) Width of existing culvert(s): 2 (a7 60'
(iv) Height of the top of the existing culvert above the NHW or
NWL: 2.5'
(v) Will all, or a part of, the existing culvert be removed?
(Explain) All
9• Width of proposed culvert. 16'-2" x 5'-1"
i. Depth of culvert to be buried below existing bottom contour.
1.7'
k. Will the proposed culvert affect existing water flow?
®Yes ❑No
If yes, explain: Enhance hydrologic flow regimes.
❑ This section not applicable
b. (i) Will the placement of the proposed bridge or culvert require any
excavation within coastal wetlands/marsh (CW), submerged
aquatic vegetation (SAV), shell bottom (SB), or other wetlands
(WL)? If any boxes are checked, provide the number of square
feet affected.
❑CW ❑SAV ❑SB
❑WL ®None
(ii) Describe the purpose of the excavation in these areas:

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: NIA
(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: 15'
(iii) Avg. width of area to be filled: 2'-4'
(iv) Purpose of fill: Bank stabiliztion.
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:
r4. GENERAL
a. Will the proposed project require the relocation of any existing
utility lines? ®Yes ❑No
If yes, explain: The waterline on the east side of the
project will be relocated resulting in 160 sq. ft. of
temporary impacts to the stream bed. The proposed
waterline will be installed by trenching while the project
is being dewatered and will be buried approximately 3
feet below the stream bed.
If this portion of the proposed project has already received
approval from local authorities, please attach a copy of the
approval or certification.
b
(1) 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 10 ❑SAV ❑SB
OWL ®None
(ii) Describe the purpose of the excavation in these areas:
Rip rap placement on shoulder for bank stabilization.
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?
�''� -.*liar ,'Ief .tlet

If yes, complete Form DCM-MP-2.
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? NYes []No
If yes, complete form MP-2, Section 3 for Shoreline
Stabilization only.
11 �/ 'Vl l
Date
NC 12 pipe replacement, 0.06 SE of SR 1233
Project Name
Ryan Shook, Environmental Specialist
— — --Ap
plicant Name
/r
pli t Signature
Using NCDOT best management practices for sediment
and erosion control.
f. Will wetlands be crossed in transporting equipment to project site?
❑Yes NNo
If yes, explain steps that will be taken to avoid or minimize
environmental impacts.

Bald
pipe _
35.26729
75.53184
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Dare County NC 12 pipe replacement
0.06 mi. SE of SR 1233 Light Plant Rd
ear
�2G -11k1-
,_ CHI
AC �.
�-
USGS Quad - Buxton
Pasquotank River Basin
0 0.125 0.25 0.5 Miles
11 I I I I 1 1 I
MOWN W.&" WIWIT
N
W E
S

Dare County NC 12 Riparian Landowners
Pipe replacement
Clara Rollinson f Shelly Rollinson i Diana Satterwhite
4331 Hollyshire Dry PO Box 351 PO Box 1583
Saint Louis, MO 63129 Buxton, NC 27920 Buxton, NC 27920 `
` Mikki Fuller �ri1
3804 Annie Ln
John F Conner, Jr � � � `
* 5
Virginia Beach, VA 23452
PO Box 71
.;g
Buxton, NC 27920 ` u
Scott Busbey
PO Box 333
Buxton, NC 27920
project :. .
i i
PO Box 333Scott Busbey
,N .r
i Buxton, NC 27920 "
_

NC GRID
NAO 83 (CORS96)
BL-2
N=570359.2470
E=3034927.3040 \\
ELEV=4.08' (BRIDGE NAIL)
\ \ Af \
SAND BAGS TO SEAL CORNER \\ \
Turbidity Curtain
DATUM DESCRIPTION
THE LOCAUEED COORDWTE SYSTEM DPSAOFED FOR THIS PROJECT
R EASED ON T11E STATE MAW COORDINATES ESIAR RED BY
MCDOT FOR MONM1ENT'1E7'
WITH MAD 83 ICOR596; STATE MANE GRID COORDINATES OF
NORTHING: 570359.74711ry EASTNG. 003E937.3WMI
ELEVATION: COW
TNT AVERAGE COMIINED GRID FACTOR USED ON 11% PROJECT
IGROUND 70 GRIq IS: 0."9073515
ALL LNEAR OWNSIONS ARE IOCAIIZED IIOREEON'TAE DISTANCES
VERTICAL DATUM USED IS NAVD N
Pll1V
DETAILED
NC-12 BUXTON
vlE H7
lDRA WI1VG
(DART; COUNTY)
EXISTING PIPE SIZES:
2 a 60' X 68' 6' CMP
j Proposed Waterline
-Turbidity Curtain -_ OMAX Buxton
BM3
N=570244
E=3035017
ELEV=4.00' R/R SPIKE
IN BASE OF POWER POLE
-PROPOSED 1 @ 16'-2" X 5'-1" X 63'-1" ABC W/ HEADWALLS
BL-I
N=570198.6530
E=3035080.5970
ELEV=3.46' (BRIDGE NAIL)
a«w�6@*""-" » AQUA BARRIER 13.5' TO 18' WIDE
ll�ri— TEMPORARY SILT FENCE
Existing Waterline
SYATaOLS
PROJ'OSED CROSS SECTION
-_-- F.X18TrNG CROSS SECTION
, OFFAR ENT OF
NORTH EUENI On1ip, N aIVISION
2 T43 AIRPORT 3821 TRANSPORTATION
RTATION
COUNTY: DARE WSSN: 1B.102811
QUAD: SUNTON DATE: AUGUST C8, 2011
BASIN: PASOUOTANK SHEET 4. 1 OF 2
SUBJEI:T. PIPF RIF-LAC.F•IENT ON NO I_ IP.0 rTON)
SAT 21.727+ n LONG. >• YC•.:531fl4 W
ORAW'N 01 J.(: n-, 1

DETAIL SECTION - CROSS SECTION
I
30'=
VAR. I
PROPOSED RIP RAP n04 FT•FT D�_.O2 FW i
ELEV. .0.78' I�
EXfSTING WATER LE'•'ELI
--------------
PROPOSED lR'•2- t �.t .� 53'-1' ABC W HEADWALLS
NOTE:
PROPOSED MPE TO BE BURIED A MINIMUM
OF I'd' SELOW EXISTING STREAM BED.
0.02 FOFT
VAR.
0.04_EjM I PROPOSED RIP RAP
FLFV •1.47'
"IS TI Yf: STREAM, BED
ELEV. •D.17'
PROPOSED PIPE BED
EXISTING 2 a 60' • 68'-8- CMP O F.X ISTIN I; WATERLINE
E l6V. •5.1 T'
PROPOSED WATERLINE
2
(I OF PAVEMENT
ELEV = 3.97'
r'lif rP OSFD RIP RAP -
-Q-�: POSED RIP RAP
EL[v 0.70
EXISTING W�f�•
EXISTING WA
c R�.P nR[D WATER LINE EXTSTr
PROPOSED 1 0 16'-2- X 5'-1" X 63'-1- ABC W/ HEADWALLS HEAD WALL
DETAIL SECTION - END VIEW
SYMBOLS
_EXISTING EXISTING CENTER LINE
PROPOSED CROSS SECTION
NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
DIVISION 1
113 AIRPORT DR.
EDENTON, NC 27932 [phone]
V •1.47,
ING STREAM BED
V -817' COUNTY: DARE WBSI: 1B.102811
OSE0 PIPE BED QUAD: BUXTON DATE: AUGUST 08, 2011
BASIN: PASOUOTANK SHEET S: 2 OF 2
SUBJECT: PIPE REPLACEMENT ON NC-12 (BUXTON)
LAT. = 35.26729 N LONG. - 75.53184
DRAWN BY: J. C. ROSS, JR SCALE: 'FBF9-'�-.,0—

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
September 22, 2011
John F Conner, Jr.
PO Box 71
Buxton, NC 27920
To Whom It May Concern,
EUGENE A. CONTI, JR.
SECRETARY
CERTIFIED MAIL
The NC Department of Transportation is proposing to replace 2 metal pipes on
NC 12 in Buxton, Dare County. The pipe is located approximately 0.06 miles southeast
from the intersection of SR 1233 ( Light Plant Rd). The existing pipes are 2 @ 60" x 68'-
6" and the proposed pipe is 1 @ 16'-2" x 5'-1" x 63'-1" Aluminum Box Culvert with
headwalls. 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
Ryan Shook 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
(Dare County: NC 12, 0.06 miles southeast of SR 1233)
I, , am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the pipe
replacement on NC 12. I am further aware that this work will occur in an AEC and
therefore will require authorization from the Division of Coastal Management in
accordance with the Coastal Area Management Act (CAMA).
I have no objection to the project as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
are attached.
I have objections to the project as presently proposed and my comments
Signature of Adjacent Landowner
Date:

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GUVE.RNOR
September 22, 2011
Scott Busbey
PO Box 333
Buxton, NC 27920
To Whom It May Concern,
EUGENE A. CONTI, JR.
SECRETARY
CERTIFIED MAIL
The NC Department of Transportation is proposing to replace 2 metal pipes on
NC 12 in Buxton, Dare County. The pipe is located approximately 0.06 miles southeast
from the intersection of SR 1233 ( Light Plant Rd). The existing pipes are 2 @ 60" x 68'-
6" and the proposed pipe is 1 @ 16'-2" x 5'-1" x 63'-1" Aluminum Box Culvert with
headwalls. 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
Ryan Shook 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
(Dare County: NC 12, 0.06 miles southeast of SR 1233)
1, , am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the pipe
replacement on NC 12. 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 (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:

d yn.q
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
September 22, 2011
Clara Rollinson
4331 Hollyshire Dr
Saint Louis, MO 63129
To Whom It May Concern,
EUGENE A. CONTI, JR.
SECRETARY
CERTIFIED MAIL
The NC Department of Transportation is proposing to replace 2 metal pipes on
NC 12 in Buxton, Dare County. The pipe is located approximately 0.06 miles southeast
from the intersection of SR 1233 ( Light Plant Rd). The existing pipes are 2 cr 60" x 68'-
6" and the proposed pipe is 1 @ 16'-2" x 5'-1" x 63'-1" Aluminum Box Culvert with
headwalls. 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
Ryan Shook 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
(Dare County: NC 12, 0.06 miles southeast of SR 1233)
I, , am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the pipe
replacement on NC 12. 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 (CAMA).
I have no objection to the project as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
are attached.
I have objections to the project as presently proposed and my comments
Signature of Adjacent Landowner
Date:

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
September 22, 2011
Shelly Rollinson
PO Box 351
Buxton, NC 27920
To Whom It May Concern,
EUGENE A. CONTI, JR.
SECRETARY
CERTIFIED MAIL
The NC Department of Transportation is proposing to replace 2 metal pipes on
NC 12 in Buxton, Dare County. The pipe is located approximately 0.06 miles southeast
from the intersection of SR 1233 ( Light Plant Rd). The existing pipes are 2 @ 60" x 68'-
6" and the proposed pipe is 1 @ 16'-2" x 5'-1" x 63'-1" Aluminum Box Culvert with
headwalls. 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
Ryan Shook 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
(Dare County: NC 12, 0.06 miles southeast of SR 1233)
I, , am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the pipe
replacement on NC 12. 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 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:

r SEW
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
September 22, 2011
Diana Satterwhite
PO Box 1583
Buxton, NC 27920
To Whom It May Concern,
EUGENE A. CONTI, JR.
SECRETARY
CERTIFIED MAIL
The NC Department of Transportation is proposing to replace 2 metal pipes on
NC 12 in Buxton, Dare County. The pipe is located approximately 0.06 miles southeast
from the intersection of SR 1233 ( Light Plant Rd). The existing pipes are 2 @ 60" x 68'-
6" and the proposed pipe is 1 @ 16'-2" x 5'-1" x 63'-1" Aluminum Box Culvert with
headwalls. 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
Ryan Shook 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
(Dare County: NC 12, 0.06 miles southeast of SR 1233)
I, __ , am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the pipe
replacement on NC 12. 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).
1 have no objection to the project as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
are attached.
I have objections to the project as presently proposed and my comments
Signature of Adjacent Landowner
Date:

STATE OF NORTII CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
September 22, 2011
Mikki Fuller
3804 Annie Ln
Virginia Beach, VA 23452
To Whom It May Concern,
EUGENE A. CONTI, JR.
SECRETARY
CERTIFIED MAIL
The NC Department of Transportation is proposing to replace 2 metal pipes on
NC 12 in Buxton, Dare County. The pipe is located approximately 0.06 miles southeast
from the intersection of SR 1233 ( Light Plant Rd). The existing pipes are 2 @ 60" x 68'-
6" and the proposed pipe is 1 @ 16'-2" x 5'-1" x 63'-1" Aluminum Box Culvert with
headwalls. 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
Ryan Shook 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
(Dare County: NC 12, 0.06 miles southeast of SR 1233)
1, , am an adjacent riparian property owner and am
aware of the North Carolina Department of Transportation's plans for the pipe
replacement on NC 12. I am further aware that this work will occur in an AEC and
therefore will require authorization from the Division of Coastal Management in
accordance with the Coastal Area Management Act (LAMA).
I have no objection to the project as presently proposed and hereby waive
that right of objection as provided in General Statute 113-229.
are attached.
I have objections to the project as presently proposed and my comments
Signature of Adjacent Landowner
Date:

(Domestic/ . Insurance Coverage• ••• m •• • • • .. ' .•
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ru 3Fn Mikki Fuller ru nt Diana Satterwhite
Ir 3804 Annie Ln
P.O. Box 1583
17�orr Virginia Beach, VA 23452 -__ ...._-. CD Buxton, NC 27920
-----------
City �;

Applicant:
Date:
Describe below the HABITAT disturbances for the application. All values should rnatch the name, and units of measurement
found in your Habitat code sheet.
Habitat Marne
DIS'! LJRB i YPE
Choose One •
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FI�iAL 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)
FI�dAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Dredge [Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill [Both ElOther El
Dredge ❑ Fill [olh ❑ Other ❑
J'
{Jrj h Cry ""�
Dredge [y Fill B— 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 ❑
I
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