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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
I S� 1 MAIL SERVICE CENTER, RntE��H, N.C. 27699-1501
PAT MCCRORY NICHOLAS J. TENNYSON
GOVERNOR SECRGTARY
August 21, 2015
U.S. Army Corps of Engineers
Regulatory Field Office
2407 West Fifth Street
Washington, NC 27889
Attention: Tracey Wheeler
Subject: Request for a Nationwide Permit 3 and 401 Water Quality Certification for the replacement of a
culvert structure on SR 1374 in Pasquotank Counry. WBS # 1B.207011
The North Carolina Department of Transportation is requesting the issuance of a Nationwide
Permit 3 and 401 Water Quality Certification for the replacement of a culvert structure on SR 1374 (Mt.
Herman Church Road) in Pasquotank County. The culvert structure is located on SR 1374 approximately
0.25 miles from SR 1144 (Foreman Bundy Road). The culvert structure is located in unnamed canal to
tributary to Little River, which is classified by NCDWR as class "C;Sw" waters. The existing culvert
structure consists of (1) 30" X 45' RCP and (1) 24" X 45' RCP. These culverts will be removed using
NCDOT's guidelines for culvert removal. The proposed (1) 95" X 67" X 40' CAAP with headwalls will be
placed on the existing atignment as shown in the permit drawings. The proposed pipe will be placed 1.5'
below the surveyed stream bed elevation. The project will result in no jurisdictional wetland or stream
impacts. The sheet pile installation and dewatering process may result in minor temporary disturbance to
the vegetated banks. This project will require the closure of SR 1374 for several days, and an ofi=site
detour will be utilized. This temporary closure will be coordinated with the local county officials and
conducted during a time period which minimizes the impact to the traveling public.
Included with this letter are the location map, PCN, and permit drawings. If you have questions
please call me at [phone].
Sincerely,
Jerry Jennings
Division gine r
P 1 illiams
Division One Environmental Specialist
Cc: Garcy Ward, NCDWR
Kristi Lynn Carpenter, NCDWR
113 Airport Drive, Suite 100, Edenton, NC 27932, Phone: [phone], Fax: [phone]

PASQUOTANK COUNTY
PIPE REPLACEMENT ON SR 1374 (MT. HERMON CHURCH ROAD)
0.125 0.25 0.5 0.75
Miles
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Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PCN Form
A. A licant 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 3 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps? � Yes ❑ No
1 d. 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
1 e. Is this notification solely for the record For the record only for DWQ 401 For the record only for Corps Permit:
because written approval is not required? Certification:
� Yes ❑ No ❑ Yes � No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation � Yes � No
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program.
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h � Yes ❑ No
below. -
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes � No
2. Project Information
2a. Name of project: Replace Culvert Structure on Mt. Herman Church Road
2b. County: Pasquotank County
2c. Nearest municipality / town: Elizabeth City
2d. Subdivision name: n/a
2e. NCDOT only, T.I.P. or state 1 B.207011
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT R-O-W SR 1374 - Pasquotank County
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if �
applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
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: Paul Williams
4c. Business name
(if applicable):
4d. Street address: 113 Airport Drive Suite 100
4e. City, state, zip: Edenton, N.C. 27932
4f. Telephone no.: 1-252-482-1861 cell phone [phone]
4g. Fax no.: 1-252-482-8722
4h. Email address: [e-mail]
5. AgentlConsultant 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): n/a
Latitude: 36.265655
1 b. Site coordinates (in decimal degrees): Longitude: - 76.318531
(DD.DDDDDD) - (-DD.DDDDDD)
1 c. Property size: 0.05 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Unnamed canal to Little River
proposed project:
2b. Water Quality Classification of nearest receiving water: C;Sw
2c. River basin: Pasquotank
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:
Project area consist of NCDOT Pasquotank County SR 1374 with unnamed canal to Little River passing under the
roadway through 1@ 30"X45' and 1@24"X45' RCP's. The adjacent property use is a mix of residential and forested area.
3b. List the total estimated acreage of all existing wetlands on the property:
none
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
60 feet
3d. Explain the purpose of the proposed project:
Replace deteriorating culverts and maintain a stabile road way along SR 1374 for the safety of the traveling public.
3e. Describe the overall project in detail, including the type of equipment to be used:
The existing (2) RCP's will be entirely removed using NCDOT guidelines for pipe removal. The proposed CAAP measuring
95" X 67" X 40' with headwalls will be placed as shown in the permit drawings. The proposed CAAP will be buried 1.5 feet
below the surveyed stream bed. Once the pipe is in place and back filled, a new roadway surtace and grassed shoulder will
be established. Some temporary disturbance to the vegetated banks will likely occur from the dewatering process. The banks
will be stabilized following NCDOT erosion control bmp's, including some rip rap stabilization as shown on the permit
drawings. There are no permanent stream or wetland impacts resulting from this maintenance project. This work will be
accom lished usin a track excavator, backhoe, and dum trucks.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property / � Yes ❑ No ❑ Unknown
project (including all prior phases) in the past?
Comments: Paul Williams, Div. 1 Environmental Specialist
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:
Name (if known): 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 � Yes � No ❑ 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

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. 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)
Tem ora 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
2h. Comments: None
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. 39•
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 ❑ PER ❑ Corps
❑ INT ❑ DWQ
S2 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
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 ❑ DWQ
3h. Total stream and tributary impacts
3i. Comments: None
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. 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
Tem ora T
01 ❑P❑T
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
4f. Total open water impacts
4g. Comments: None
5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
Sf. Total
5g. Comments: none
5h. Is a dam high hazard permit required?
❑ Yes � No If yes, permit ID no:
5i. Expected pond surface area (acres): n/a
5j. Size of pond watershed (acres): n/a
5k. Method of construction: n/a
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 an im acts re uire miti ation, then ou MUST fill out Section D of this form.
6a.
❑ Neuse ❑ Tar-Pamlico ❑ Other:
Project is in which protected basin? ❑ Catawba ❑ Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number — Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Tem ora T im act re uired?
B� �P�T ❑Yes
❑ No
B2 �P�T ❑Yes
❑ No
B3 ❑P❑T ❑Yes
❑ No
6h. Total buffer impacts
6i. Comments: none
Page 6 of 11
PCN Form — Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Culvert replacement will stay on the existing alignment and traffic will be detoured around the site by using an off-site detour.
This will reduce temporary impacts to the stream by not utilizing an on-site detour and keeping the road open.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Turbidity curtains and sheet piling will be used during the pipe replacement to reduce suspended sediments in the water
column. NCDOT will follow our BMP's during pipe removal/installation and install erosion control devices to prevent sediment
loss from the project site.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ❑ Yes � No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ❑ DWQ ❑ Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this
project? ❑ Payment to in-lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank: n/a
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments: n/a
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: n/a
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.
n/a
Page 7 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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 � No
buffer mitigation?
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).
n/a
6h. Comments: n/a
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
1 a. Does the project include or is it adjacent to protected riparian buffers identified � Yes � No
within one of the NC Riparian Buffer Protection Rules?
1 b. if yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
Comments:
2. Stormwater Mana ement 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 will follow best management practices for soil and erosion control in compliance with N.C. Sediment and
Pollution Control Act and NCDOT NPDES permit. During installation of the culvert a turbidity curtain will be placed in the
stream, on the culvert outlet ends, and sheet piling will be used to dewater the site.
❑ Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ❑ DWQ Stormwater Program
� DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local governmenYs jurisdiction is this project? N/A
❑ Phase II
3b. Which of the following locally-implemented stormwater management programs ❑ NSW
apply (check all that apply): ❑ USMP
❑ Water Supply Watershed
� � Other: N/A
3c. Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑ No
attached?
4. DWQ Stormwater Pro ram 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
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? ❑ Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met? ❑ Yes ❑ No
Page 9 of 11
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project 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 project (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 waste water will be generated from this project
Page 10 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirementj
5a. Will this project occur in or near an area with federafly protected species or � Yes � No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act � Yes � No
impacts?
❑ Raleigh
5c. If yes, indicate the USFWS Fiefcf O�ce you have contacted.
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC 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?
National Marine Fisheries Database
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this projecf occur in ar 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?
NC State Historic Preservation Data
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: Structure design complies with Hyd�aulic Engineer designs
8c. What source(s} did you use to make the floodplain determination? NC Flood Maps
I
�
Paul Williams 8/21/2015
Applicant/AgenYs Printed Name Applicant/AgenYs Signature Date
(Agent's signature is valid only if an authorization letter from the applicant
is rovided.
Page 11 of 11
PCN Form — Version 1.3 December 10, 2008 Version

PROPOSED RIP RAP
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NATURAL WATER LEVEL i���
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EXIST. STREAM BED
DETAIL SECTI01�
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VARIABLE
PROPOSED RIP RAP
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PROPOSED PIPE BED
PROPOSED 1�a 95" x 67" x 40'
CORR UGATED AL UMINUM PIPE
WITH HEADWALLS
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EXISTING
—1 @ 30" x 45' RCP
& 1@ 24" x 45' RCP
NOTES: * PROPOSED 1@ 95" x 67" X 40' CORRUGATED ALUMINUM PIPE TO BE BURIED 1.5' BELOW EXISTING STREAM BED
* ALL ELEVATIONS BASED ON ASSUMED DATA
EXISTING
� OF PAVEMENT "
21 .75'
SYMBOLS
PROPOSED CROSS SECTION
- - - - - - EXISTIIVG CROSS SECTI011t
EXISTING WATERLINE TO BE RELOCATED EXISTING
EXISTING 1@ 30" x 45' RCP _
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1@ 24" x 45' RCP WATER LEVEL 16.31'
STREAM BED 15.5�' _ _ _ _ _ _ _ _ _�� _ � _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
- ------- �--�--- ---------------- ----------
EXISTING PIPE BED 15.15' DIVISION 1
PROPOSED PIPE BED �a.o�' 113 AIRPORT DR.
— — — — — — — — — — — — — — EDENTON, NC 27932 [phone]
PR OPOSED
\ 1@ 95" x 67" x 40' CAP
WITH HEADWALLS
NOTES: PROPOSED 1@ 95" x 67" x 40' CORRUGATED ALUMINUM PIPE TO BE BURIED 1.5' BELOW EXISTING STREAM BED
*ALL ELEVATIONS BASED ON ASSUMED DATA
DETAIL SECTI011t - O UTLET E1�D VIEW
CoUNTY: PASQUOTANK WBS#: 1 B.20701 1
QUAD: PASQUOTANK DATE: JULY 9, 2015
BASIN: PASQUOTANK SHEET #: 2 OF 2
REPLACE PIPE CULVERT ON SR 1374 MT HERMON CHURCH RD
LAT. = 36.265655 N LONG. = 76.318531 W
DRAWN BY: D.H. STALLINGS SCALE: 1" = 5'

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Elizabeth City NC 27909
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PROPOSED I� 95" x 67" x 40' CAP
WITH HEADWALLS