20120770 Ver 1_Application_20120815

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STATE OF NORTH CAROLINA ZNR sZQ�
DEPARTMENT OF TRANSPORTATIC4,,*o��,ry Z
BEVERLY EAVES PERDUE q�R
GOVERNOR EUGE CONTI JR
SECRETARY
August 3 2012
U S Army Corps of Engineers
Regulatory Field Office
Post Office Box 1000
Washington N C 27889 1000
120"7'i 0
Attention Bill Biddlecome
Subject Request for a NW 14 permit and DWQ 401 Certification for a secondary road widening project on
SR 1340 (Clayton House Rd) in Martin County
The North Carolina Department of Transportation is requesting a NW 14 permit for impacts
resulting from road improvements on SR 1340 (Clayton House Rd) in Martin County NCDOT proposes to
widen the existing gravel road from 18 to a 20 paved surface width with the ditchline being set back and
shoulders being adjusted to accommodate a wider paved surface After avoidance and mimmization the
remaining unavoidable impacts are 14 lmear feet of open water impacts (ditch through hydnc soil)
Included with this letter are the PCN form vicinity map pernut drawings 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
Division One Envi nmental Officer
Cc Garcy Ward DWQ
Sonia Greeory 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
Pre - Construction Notification (PCN) Form
A Applicant Information
1
Processing
1 a
Type(s) of approval sought from the
Corps
Section 404 Permit
® ❑ 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?
as ❑ 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 lieu
fee program
❑Yes No
1g
Is the project located in any of NC s twenty coastal counties If yes answer 1h
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 1340 Clayton House Rd
2b
County
Martin
2c
Nearest municipality / town
Hamilton
2d
Subdivision name
2e
NCDOT only T I P or state
project no
State Project no 1 C 058035
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

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 I
Property Identification
1a Property identification no (tax PIN or parcel ID)
lb Site coordinates (in decimal degrees)
Latitude 35 94118 Longitude 7723442
(DD DDDDDD) (DD DDDDDD)
1 c Property size
2 acres
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
proposed project
Conoho Creek
2b Water Quality 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 rural residential
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
0
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 past?
❑ Yes ® No ❑ Unknown
Comments
4b If the Corps made the jurisdictional determination what type
of determination was made'
❑ Preliminary ❑ Final
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
this project (including all prior phases) in the pasY� TO
Yes ® No ❑ Unknown
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

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
Wetland impact
2b
2c
2d
2e
Type of jurisdiction
2f
number —
Permanent (P) or
Type of impact
Type of wetland
Forested
(Corps 404 10
Area of impact
Temporary T
(if known)
DWQ — non -404 other)
(acres)
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
El Yes
El 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
Permanent (P) or
(PER) or
(Corps 404 10
stream
length
Temporary (T)
intermittent
(INT)?
DWQ — ror, 404
other)
width
(feet)
(linear
feet)
S1 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ IAIT
❑ DVvQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
E] DWQ
3h Total stream and tributary impacts
31 Comments
Page 5 of 11
PCN Form — Version 1 3 December 10 2008 Version

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
Open water
impact number —
Permanent (P) or
Temporary T
4b
Name of waterbody
(if applicable)
4c
Type of impact
4d
Waterbody type
4e
Area of impact (acres)
01 ®P ❑ T
UT to Conoho
Creek
fill (pipe)
wetland equalizer
(ditch cut through
hydric soil)
00006
02 P ❑T
❑
03 ❑P ❑T
04 ❑P ❑T
4f Total open water impacts
00006
4g Comments 28 sq ft (14 linear ft) of impact resulting from installation of longer pipe
5 Pond or Lake Construction
If and or lake construction proposed then complete the chart below
5a
Pond ID
number
5b
Proposed use or purpose
of pond
5c
Wetland Impacts (acres)
5d
Stream Impacts (feet)
5e
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f Total
5g Comments
5h Is a dam high hazard permit required
❑ Yes ❑ No If yes permit ID no
51 Expected pond surface area (acres)
5j Size of pond watershed (acres)
5k Method of construction
Page 6 of 11
PCN Form — Version 1 3 December 10 2008 Version

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
Tem ora T im act
B1 ❑P ❑T
B2 ❑P ❑T
B3 ❑P ❑T
61 Comments
LD Impact Justification and Mitigation
❑ Neuse ❑ Tar Pamlico ❑ Other
❑ Catawba ❑ Randleman
6e 6f 6g
Buffer
Stream name mitigation
required?
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
E01 No
6h Total buffer impacts
Zone 1 impact Zone 2 impact
(square feet) (square feet)
1 Avoidance and Minimization
la Specifically descrbe measures taken to avoid or minimize the proposed impacts in designing project
Impacts were minimized by reducing pipe lengths from 60 to 48 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?
2b If yes mitigation is required by (check all that apply)
2c If yes which mitigation option will be used for this
project
3 Complete if Using a Mitigation Bank
3a Name of Mitigation Bank
3b Credits Purchased (attach receipt and letter)
❑ Yes ® No
❑ DWQ ❑ Corps
❑ Mitigation bank
❑ Payment to in lieu fee program
❑ Permittee Responsible Mitigation
Type I Quantity
Page 7 of 11
PCN Form — Version 1 3 December 10 2008 Version

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
6 Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a Will the project result in an impact within a protected riparian buffer that requires ❑ Yes
buffer mitigation? 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
6c 6d 6e
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet)
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1 5
6f Total buffer mitigation required
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)
F6hComments
Page 8 of 11
PCN Form — Version 1 3 December 10 2008 Version

E Stormwater Management and Diffuse Flow Plan (required by DWQ)
1 Diffuse Flow Plan
la Does the project include or is it adjacent to protected riparian buffers identified
within one of the NC Riparian Buffer Protection Rules? ❑ Yes ® No
lb If yes then is a diffuse flow plan included? If no explain why
Comments ❑ Yes ❑ No
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
2e Who will be responsible for the review of the Stormwater Management Plan?
3 Certified Local Government Stormwater Review
3a In which local governments jurisdiction is this project?
3b Which of the following locally implemented stormwater management programs
apply (check all that apply)
3c Has the approved Stormwater Management Plan with proof of approval been
attached?
4 DWQ Stormwater Program Review
4a Which of the following state implemented stormwater management programs apply
(check all that apply)
4b Has the approved Stormwater Management Plan with proof of approval been
attached?
5 DWQ 401 Unit Stormwater Review
5a Does the Stormwater Management Plan meet the appropriate requirements?
5b Have all of the 401 Unit submittal requirements been met?
❑ Certified Local Government
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
n/a
❑ Phase II
❑ NSW
❑ USMP
❑ Water Supply Watershed
❑ Other
❑ Yes ❑ No
❑ Coastal counties
❑ HQW
❑ ORW
❑ Session Law 2006 246
® Other NCDOT stormwater
permit No NCGO10000
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
Page 9 of 11
PCN Form — Version 1 3 December 10 2008 Version

F Supplementary information
1 Environmental Documentation (DWQ Requirement)
la Does the project involve an expenditure of public (federal /state /local) funds or the
use of public (federal /state) land? ® Yes ❑ No
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)?
1c 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 project (based on past and reasonably anticipated future impacts) result in
additional development which could impact nearby downstream water quality? [01 Yes No
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

5 Endangered Species and Designated Critical Habitat (Corps Requirement)
5a Will this project occur in or near an area with federally protected species or
habitat? ❑ Yes ® No
5b Have you checked with the USFWS concerning Endangered Species Act
impacts? I ❑ Yes ® No
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 0 N
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
status (e g National Historic Trust designation or properties significant in E] Yes No
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 7/26/12
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
Applicant/Agent s Printed Name plicant/Agent s Signature Date
(Agent s signature is valid only if an authorization letter from the applicant
Page 11 of 11
PCN Form — Version 1 3 December 10 2008 Version

Martin County SR 1 340 Clayton House Rd
End project
35.9402i7
- 77.234152
_ a
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grade, drain, base, and pave
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