20120671 Ver 1_Application_20120711

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�. SrATE -41
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STATE OF NORTH CAROLINA
SOS
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE EUGENE A COl'd1F1 JR.
GOVERNOR SECRETARY
July 2 2012
U S Army Corps of Engineers
Regulatory Field Office
Post Office Box 1000
Washington NC 27889 1000
i2ocz1
Attention Bill Biddlecome
Subject Request for a NW 14 permit and DWQ 401 Certification for a secondary road widening project on
SR 1325 (Old Cotten Rd) in Martin County
The North Carolina Department of Transportation is requesting a NW 14 permit for impacts
resulting from road improvements on SR 1325 (Old Cotton Rd) in Martin County NCDOT proposes to
widen the existing gravel road from 18 to a 20 paved surface width with the ditchlme being set back and
shoulders being adjusted to accommodate a wider paved surface After avoidance and minimization the
remaining unavoidable impacts are 36 linear feet of stream impact resulting from pipe replacement
Included with this letter are the PCN form vicinity map permit drawmgs and aerial photos If
you need any additional information or have any questions concerning this project please contact Ryan
Shook at 252 482 7977
Sincerely
Jerry Jennings P E
Division One Engineer
Clay Willis /�j Z/�
Division One Envirozental Officer
Cc Garcy Ward DWQ
Sonia Gregory DWQ
113 Airport Drive Suite 100 Edenton NC 27932 Phone [phone] Fax [phone]

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Office Use Only
Corps action ID no
DWQ project no
Form Version 1 3 Dec 10 2008
Page 1 of 11
PCN Form — Version 1 3 December 10 2008 Version
Pre - Construction Notification (PCN) Form
A Applicant Information
1
Processing
la
Type(s) of approval sought from the
Corps
®Section 404 Permit El Section 10 Permit
1 b
Specify Nationwide Permit (NWP) number NW 14 or General Permit (GP) number
1c
Has the NWP or GP number been verified by the Corps?
❑ Yes
❑ No
1d
Type(s) of approval sought from the DWQ (check all that apply)
® 401 Water Quality Certification — Regular ❑ Non 404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
le
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification
❑ Yes ® No
For the record only for Corps Permit
❑ Yes ® No
1f
Is payment into a mitigation bank or in lieu fee program proposed for mitigation
of impacts If so attach the acceptance letter from mitigation bank or in'
n lieu
fee program
El Yes
El No
1g
Is the project located in any of NC s twenty coastal counties If yes answer 1 h
below
❑ Yes
® No
1h
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2
Project Information
2a
Name of project
SR 1325 Old Cotten Rd
2b
County
Martin
2c
Nearest municipality / town
Oak City
2d
Subdivision name
2e
NCDOT only T I P or state
project no
State Project no 1 C 058033
3
Owner Information
3a
Name(s) on Recorded Deed
NCDOT
3b
Deed Book and Page No
n/a
3c
Responsible Party (for LLC if
applicable)
NCDOT Division One
3d
Street address
113 Airport Drive Suite 100
3e
City state zip
Edenton NC 27932
3f
Telephone no
252 482 7977
3g
Fax no
252 482 8722
3h
Email address
tcwillis @ncdot gov
Page 1 of 11
PCN Form — Version 1 3 December 10 2008 Version

t Q
4 Applicant Information (if different from owner)
4a Applicant is
❑ Agent ❑ Other specify
4b Name
4c Business name
(if applicable)
4d Street address
4e City state zip
4f Telephone no
4g Fax no
4h Email address
5 Agent/Consultant Information (if applicable)
5a Name
5b Business name
(if applicable)
5c Street address
5d City state zip
5e Telephone no
5f Fax no
5g Email address
Page 2 of 11
PCN Form — Version 1 3 December 10 2008 Version

B Project Information and Prior Project History
1 Property Identification
1a Property identification no (tax PIN or parcel ID)
1 b Site coordinates (in decimal degrees)
Latitude 35 93428 Longitude 7731916
(DD DDDDDD) ( DD DDDDDD)
1 c Property size
15 acres
2 Surface Waters
2a Name of nearest body of water (stream river etc) to
Conoho Creek
proposed project
2b Water Ouality Classification of nearest receiving water
C
2c River basin
Roanoke
3 Project Description
3a Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application
The existing gravel road is 18 wide with 3 4 variable grass shoulders Land use within the project area is agricultural
and forrested
3b List the total estimated acreage of all existing wetlands on the property
<1
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
240
3d Explain the purpose of the proposed project
To build the existing road to a 20 paved surface with relocation of ditches and widening of shoulders
3e Describe the overall project in detail including the type of equipment to be used
To upgrade an existing gravel secondary road from 18 to 20 wide paved surface with 4 5 shoulders pipe replacement
Ditches will have to be set back in order to accommadate the widening of shoulders Heavy equipment to be used will be
an excavator backhoe motor grader and dumptrucks
4 Jurisdictional Determinations
4a Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the pasty
El Yes ®No El Unknown
Comments
4b If the Corps made the jurisdictional determination what type
El Preliminary Final
of determination was made?
4c If yes who delineated the jurisdictional areas?
Agency /Consultant Company NCDOT
Name (if known) Ryan Shook
Other
4d If yes list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
5 Project History
5a Have permits or certifications been requested or obtained for
El Yes No El Unknown
this project (including all prior phases) in the past
5b If yes explain in detail according to help file instructions
Page 3 of 11
PCN Form — Version 1 3 December 10 2008 Version

(.
6 Future Project Plans
6a Is this a phased project? ❑ Yes ® No
6b If yes explain
Page 4 of 11
PCN Form — Version 1 3 December 10 2008 Version

f k
C Proposed Impacts Inventory
1 Impacts Summary
la Which sections were completed below for your project (check all that apply)
❑ Wetlands ® Streams tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2 Wetland Impacts
If there are wetland impacts proposed on the site then complete this question for each wetland area impacted
2a
2b
2c
2d
2e
2f
Wetland impact
Type of jurisdiction
number—
Type of impact
Type of wetland
Forested
(Corps 404 10
Area of impact
Permanent (P) or
(if known)
DWQ — non 404 other)
(acres)
Temporary T
W1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g Total wetland impacts
0
2h Comments
3 Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site then complete this
question for all stream sites impacted
3a
3b
3c
3d
3e
3f
3g
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number
(PER) or
(Corps 404 10
stream
length
Permanent (P) or
intermittent
DWQ — non 404
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ®P ❑ T
fill from pipe
UT to Conoho
® PER
® Corps
7
12
replacement
Creek
❑ INT
® DWQ
S2 ®P ❑ T
fill from pipe
UT to Conoho
❑ PER
® Corps
3
14
replacement
Creek
® INT
® DWQ
S3 ® P ❑ T
fill from pipe
UT to Conoho
® PER
® Corps
3
10
replacement
Creek
❑ INT
® DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h Total stream and tributary impacts
36
31 Comments All stream impacts are resulting from the lengthing of the original pipes during replacement
Page 5 of 11
PCN Form — Version 1 3 December 10 2008 Version

r k
4 Open Water Impacts
If there are proposed impacts to lakes ponds estuaries tributaries sounds the Atlantic Ocean or any other open water of
the U S then individually list all open water impacts below
4a 4b 4c 4d 4e
Open water Name of waterbody
impact number — (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P ❑T n/a
02 ❑ PEI T
03 ❑P ❑T
04 ❑P ❑T
4f Total open water impacts 0
4g Comments
5 Pond or Lake Construction
If pond or lake construction proposed then complete the chart below
5a I 5b I 5c 5d 5e
Pond ID Proposed use or purpose
number of pond
Wetland Impacts (acres) I Stream Impacts (feet)
Flooded I Filled I Excavated I Flooded I Filled I Excavated
P1
P2
5f Total
5g Comments
5h Is a dam high hazard permit required
❑ Yes ❑ No if yes permit ID no
Upland
(acres)
Flooded
51 Expected pond surface area (acres)
51 Size of pond watershed (acres)
5k Method of construction
6 Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer then complete the chart below If yes then individually list all buffer impacts
below If any impacts require mitigation then you MUST fill out Section D of this form
6a
Project is in which protected basin?
6b 6c 6d
Buffer impact
number — Reason
Permanent (P) or for
Temporary (T) impact
B1 ❑P ❑T
B2 ❑P ❑T
B3 ❑P ❑T
61 Comments
❑ Neuse ❑ Tar Pamlico ❑ Other
❑ Catawba ❑ Randleman
6e I 6f I 6g
Buffer
Stream name mitigation
required?
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
6h Total buffer impacts
Zone 1 impact Zone 2 impact
(square feet) (square feet)
Page 6 of 11
PCN Form — Version 1 3 December 10 2008 Version

D Impact Justification and Mitigation
1 Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
Impacts were minimized by reducing pipe lengths from 60 to 50 in order to obtain the minimum shoulder width needed at
stream crossing locations
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Methods of construction will be concurrent with NCDOT Best Management Practices for replacement of pipes and for sod and
erosion control Staged construction will be utilized and the road will be closed or reduced to one lane of traffice during pipe
replacements rather than using an on site detour in order to minimze the proposed impacts
2 Compensatory Mitigation for Impacts to Waters of the U S or Waters of the State
2a Does the project require Compensatory Mitigation for
impacts to Waters of the U S or Waters of the State?
❑ Yes ® No
2b If ye,, mite ation v, iequiied by (check all that apply)
❑ DWQ ❑ Corps
2c If yes which mitigation option will be used for this
project?
❑ Mitigation bank
❑ Payment to in lieu fee program
❑ Permittee Responsible Mitigation
3 Complete if Using a Mitigation Bank
3a Name of Mitigation Bank
3b Credits Purchased (attach receipt and letter)
Type --FQuantity
3c Comments
4 Complete if Making a Payment to In lieu Fee Program
4a Approval letter from in lieu fee program is attached
❑ Yes
4b Stream mitigation requested
linear feet
4c If using stream mitigation stream temperature
❑ warm ❑ cool ❑cold
4d Buffer mitigation requested (DWQ only)
square feet
4e Riparian wetland mitigation requested
acres
4f Non riparian wetland mitigation requested
acres
4g Coastal (tidal) wetland mitigation requested
acres
4h Comments
5 Complete if Using a Permittee Responsible Mitigation Plan
5a If using a permittee responsible mitigation plan provide a description of the proposed mitigation plan
Page 7 of 11
PCN Form — Version 1 3 December 10 2008 Version

C
6 Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation'?
❑ Yes ® No
6b If yes then identify the square feet of impact to each zone of the riparian buffer that requires mitigation Calculate the
amount of mitigation required
Zone
6c
Reason for impact
6d
Total impact
(square feet)
Multiplier
6e
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1 5
6f Total buffer mitigation required
6g If buffer mitigation is required discuss what type of mitigation is proposed (e g payment to private mitigation bank
permittee responsible riparian buffer restoration payment into an approved in lieu fee fund)
6h Comments
Page 8 of 11
PCN Form — Version 1 3 December 10 2008 Version

0` r
E
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1
Diffuse Flow Plan
1 a
Does the project include or is it adjacent to protected riparian buffers identified
El Yes ®No
within one of the NC Riparian Buffer Protection Rules?
lb
If yes then is a diffuse flow plan included? If no explain why
❑ Yes E:1 No
Comments
2
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
n/a %
2b
Does this project require a Stormwater Management Plan?
® Yes ❑ No
2c
If this project DOES NOT require a Stormwater Management Plan explain why
2d
If this project DOES require a Stormwater Management Plan then provide a brief narrative
description of the plan
NCDOT state stormwater permit for highway system is applicable NCDOT will follow
guidelines for Erosion and
Sediment Control
❑ Certified Local Government
2e
Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
'KDWQ 401 Unit
3
Certified Local Government Stormwater Review
3a
In which local government s jurisdiction is this project?
n/a
❑ Phase II
3b
Which of the following locally implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply)
El Water Supply Watershed
NN/A
❑ Other
3c
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached? N /a.
4
DWQ Stormwater Program Review
❑ Coastal counties
❑ HQW
4a
Which of the following state implemented stormwater management programs apply
❑ ORW
(check all that apply)
❑ Session Law 2006 246
® Other NCDOT stormwater
permit No NCG010000
4b
Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ® No
5
DWQ 401 Unit Stormwater Review
5a
Does the Stormwater Management Plan meet the appropriate requirements? N/A
❑ Yes ❑ No
5b
Have all of the 401 Unit submittal requirements been met? r414
❑ Yes ❑ No
Page 9 of 11
PCN Form — Version 1 3 December 10 2008 Version

Martin County SR 1325 Old
Cotten
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grade, drain, base, &
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1
Site 3 permit A=
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35.93446
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- 77.32779
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Site 1 permit
-- —
Site 2 permit +
35.93428
35.93412
- 77.31916
- 77.32202
USGS Quad - Oak City
N
Roanoke River Basin 0 0.25 0.5
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1 Miles W
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s

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Martin County SR 1325 Old Cotten Rd
grade, drain, base, & pave
X327 ,
Y
End
35.94464
- 77.34373
Ask
Site 3 permit
35.93446
- 77.32779
USGS Quad -Oak City
Roanoke River Basin
Site 2 permit
35.93412
- 77.32202
Site 1 permit
35.93428
- 77.31916
0 0.25 0.5 1 Miles
� •,fir .� � .
,a
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- 77.31222
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N
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S

F
Supplementary Information
1
Environmental Documentation (DWQ Requirement)
la
Does the protect involve an expenditure of public (federal /state /local) funds or the
® Yes
❑ No
use of public (federal /state) land?
1 b
if you answered yes to the above does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes
® No
(North Carolina) Environmental Policy Act (NEPA /SEPA)?
1 c
If you answered yes to the above has the document review been finalized by the
State Clearing House? (If so attach a copy of the NEPA or SEPA final approval
letter )
❑ Yes
❑ No
Comments
2
Violations (DWQ Requirement)
2a
Is the site in violation of DWQ Wetland Rules (15A NCAC 2H 0500) Isolated
Wetland Rules (15A NCAC 2H 1300) DWQ Surface Water or Wetland Standards
❑ Yes
® No
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2b
Is this an after the fact permit application?
❑ Yes
® No
2c
If you answered yes to one or both of the above questions provide an explanation of the violation(s)
3
Cumulative Impacts (DWQ Requirement)
3a
Will this protect (based on past and reasonably anticipated future impacts) result in
❑ Yes
® No
additional development which could impact nearby downstream water quality?
3b
If you answered yes to the above submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy If you answered no provide a short narrative description
4
Sewage Disposal (DWQ Requirement)
4a
Clearly detail the ultimate treatment methods and disposition (non discharge or discharge) of wastewater generated from
the proposed project or available capacity of the subject facility
No wastewater will be created from this project
Page 10 of 11
PCN Form — Version 1 3 December 10 2008 Version

AL
5 Endangered Species and Designated Critical Habitat (Corps Requirement)
5a Will this project occur in or near an area with federally protected species or
El Yes ®No
habitat?
5b Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ® No
impacts?
5c If yes indicate the USFWS Field Office you have contacted
❑ Raleigh
❑ Asheville
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Natural Heritage database
6 Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ® No
6b What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Marine Fisheries Essential Fish Habitat List
7 Historic or Prehistoric Cultural Resources (Corps Requirement)
7a Will this project occur in or near an area that the state federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes ® No
status (e g National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b What data sources did you use to determine whether your site would impact historic or archeological resources?
A request was submitted to NCDOT s Cultural Resource office on 7/2/12
8 Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA designated 100 year floodplain?
® Yes ❑ No
8b If yes explain how project meets FEMA requirements n/a
8c What source(s) did you use to make the floodplain determination? NC Flood Mapping Information System
Clay Willis
& ( -1/12
Applicant/Agent s Printed Name
Date
Ap ant/Agent s Signature
(Agent s signature is valid only if an authorization letter from the applicant
is provided )
Page 11 of 11
PCN Form — Version 1 3 December 10 2008 Version