20070256 Ver 1_Application_20070104

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DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
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December 27,2006 ~ ~ ~ `-~ v
N.C. Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, N.C. 27699-1650
Attention: David Wainwright
Subject: Request for Individua1401 certification for road improvements on SR 1110 (Old Columbia Road)
in Tyrrell County.
The North Carolina Department of Transportation is requesting an individua1401 certification for
impacts to 404 jurisdictional wetlands. The project will impact 19,509 sq. ft. (0.447 acres) do to fill and
10,129 sq. ft (0.23 acres) do to excavation. The fill in wetlands will serve as the roadbed for the road
improvement. The excavation in wetlands will be for drainage ditches running parallel with the road. The
project will be widening an existing gravel road from 16-18 ft. wide to a paved surface of 24 ft. wide with
5- 6 ft. shoulders for a distance of 0.8 miles. The road has been realigned to the north through much of the
project in an effort to reduce impacts to wetlands. The road shoulder in wetland areas was reduced to 5 ft.
from 6 ft. to reduce wetland impacts. This road is being improved to handle increased traffic volumes
incase traffic on US 64 has to be routed along this road. Mitigation for this project will be provided through
the EEP program for impacts to riverine wetlands. Included with this request are an ENG form 4345,
vicinity map, and permit drawings detailing the proposed project and wetland impacts. If you need any
additional information or have any questions concerning this project please call me at 252-482-7977.
Sincerely,
Anthony Roper
Division One Engineer
Clay Willis ~~ l
Division One Environmental Officer
Cc: Garcy Ward, DWQ
Bill Biddlecome, USACCE

N
0 7501,500 3,000 Feet

SR 1110 Old Columbia Rd.
0 750 1,500 3,000 Feet

APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT ~ OMB APPROVAL NO. 0710-0003
/33 CFR 3T5/ Expires December 31, 2004
The Public burden for this collection of information is sestimated to average 10 hours per response, although the majority of applications should require
5 hours or less. This includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Service Directorate of Information
Operations and Reports, 1215 .Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302; and to the Office of Management and Budget,
Paperwork Reduction Project (0710-00031, Washington, DC 20503. Respondents should be aware that notwhhatanding any other provision of law,
no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control
number. Reese DO NOT RETURN your form to either of those addresses. Completed applications must be submitted to the District Engineer having
jurisdiction over the location of the proposed activity.
PRIVACY ACT STATEMENT
Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection ,Research and
Sanctuaries Act, 33 USC 1413, Section 103. Principe! Purpose: Information provided on this form will be used in evaluating the application for a
permit. Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local government agencies.
Submission of requested information is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit
be issued.
One set of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this
application (see sample drawings and instruetans) and be submitted to the District Engineer having jurisdiction over the location of the proposed
activity. An application that is not completed in full will be returned.
1. APPLICATION NO. ~ 2. FIELD OFFICE CODE ~ 3. DATE RECEIVED ~ 4. DATE APPLICATION COMPLETED
/1TFMS RFJ nW TO RF FJ/ 1 Fn RY dPP/ lCdNTI
5. APPLICANT'S NAME 8. AUTHORIZED AGENT'S NAME AND TITLE /an eaant is not reouiredl
NCDOT Division One Clay Willis
6. APPLICANT'S ADDRESS 9. AGENT'S ADDRESS
113 Airport Drive Suite 100
Edenton, N.C. 27932
?. APPLICANT'S PHONE NOS. W/AREA CODE 10. AGENT'S PHONE NOS. W/AREA CODE
a. Residence a. Residence
b. Business 2 5 2- 4 8 2- 7 9 7 7 ~ b. Business
1 1. STATEMENT OF AUTHORIZATION
I hereby authorize, to act in my behalf as my agent in the processing of this application and to
furnish, upon request, supplemental information in support of this permit application.
APPLICANT'S SIGNATURE DATE
NAME, LOCATION AND DESCRIPTION OF PROJECT OR ACTIVITY
12. PROJECT NAME OR TITLE fseeinsuucfions-
R-4452 (SR 1110 Old Columbia Road) Tyrrell County
13. NAME OF WATERBODY. IF KNOWN rlt snnticrbml 114. PROJECT STREET ADDRESS lit applicable!
Swamp adjacent to Scuppernong River I SR 1110 Old Columbia Road, Tyrrell County
15. LOCATION OF PROJECT
Tyrrell North Carolina
COUNTY STATE
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN, rsee instructions/
2 miles .,~~,st of Columbia
17. DIRECTIONS TO THE SITE
Travel East on US 64 and turn right on to SR 1110 approximately 0.5 miles from the
Scuppernong River. The project begins about 1.0 miles from that intersection.
R 4 u 7 EDITION OF FEB 94 IS OBSOLETE. (Proponent: CECW-OR)

18. Nature of Activity {Descripion of poject, include etl feetwes)
Up grading an existing gravel secondary road from a 16-18 ft. road surface to a 24 ft. wide
paved surface with 5-6 ft. shoulders. The roadway will be realigned to the north as shown on
the provided permit drawings. The roadway was realigned to the north to minimize impacts to
wetlands. The shoulder on the southside of the road was reduced by 1 ft. to minimize impacts
to wetlands. Were feasible roadside ditches in wetlands were eliminated.
19. PfOject PurpOSe /Oescrihe the reason or purpose of the poject, see instrucTionsl
Upgrading an existing gravel secondary road to a roadway design that can function properly
with a increase in traffic volume.
USE BLOCKS 20-22 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED
20. Reason(s) for Discharge
The discharge into wetlands will be to create a roadbed and shoulder area.
21. Types! of Material Being Discharged and the Amount of Each Tvoe in Cubic Yards
Sandy material that will compact to create a stable roadbed. There will be approximately 722
cubic yards of fill material discharged into wetlands.
22. Surface Area in Acres of Wetlands or Other Waters Filled /seeinsrructionsl
19509 square feet of area to be filled. There will be 10129 square feet of excavation in
wetland that is for the construction of drainage ditches adjacent to the road shoulder.
23. Is Any Portion of the Work Already Complete? Yes ~ No " IF YES. DESCRIBE THE COMPLETED WORK
24. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoi/ns the Waterbody (lf more than can be entered here,
please attach a supplemental Iistl.JLa~~r,df• / ~~ ~ ~p~G1S ~~ ~i4.rsi0 k~ d~ ~.1Y. C,:~ /'~ s/~`~~~~
~( f ,
'~~'`~Sfl/e~ F. S,O•u~/~, `Oj .do6~~, Plo%s~ sJ <°J"" ~C C/ec~ ~ G~ f><irrCG ~ l~i~~t~1
A O l
7~ L tS t ~"'Jc Cu~Y ~~+ , ~~ Tip°i'''x7 A . J ~c .~- 1.c.,s~/ ~ G . ~j.'L ~A~/
25. List of Other Certifications or ApprovalslDenials Received from other Federal, State or Local Agencies for Work Described in This Application.
ACitNCY TYPE APPROVAL' IDENTIFICATION NUMBER DATE APPLIED DATE APPROVED DATE DENIED
NCDWQ 401 12/28/06
certification
'Would include but is not restricted to zoning, building and flood plain permits
26. Application is hereby made for a permit or permits to authorize the work described in this application. I certify that the information in this
application is complete and accurate. I further certify that I possess the authority to undertake the work described herein or am acting as the
duly authorized agent of the applicant.
l i~. 2 7 ~
SIG TORE OF APPLICANT DATE SIGNATURE OF AGENT DATE
The application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly
authorized agent if the statement in block 1 1 has been filled out and signed.
18 U.S.C, Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States
knowingly and willfully falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false, fictitious or
fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious or
fraudulent statements or entry, shall be fined not more than $10,000 or imprisoned not more than five years or both.

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