19991459 Ver 1_Complete File_19991229

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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
DIVISION 'OF HIGHWAYS
DIVISION Two
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99
Division Two Office
P. O. Box 1387
Greenvil1e, NC 27833
Telephone Number (232) 830»3490
Fax Number [phone]
0
Date: /01/020'r
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Please deliver the followinS pages to:
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DWQ ID: CORPS ACTION W:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT 4) Emergency Permit
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1. NOTIFICATION TO THE CORPS OF ENGINEERS
2. APPLICATION FOR SECTION 401 CERTIFICATION
3. COORDINATION W11H THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY,,OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD
OFFICE OF THE CORPS Of ENGR4EiRS (SEE AGENCY ADDRESSES SHEET). SEVEN
COPIES MUST BE SENT TO THE NC DIVISION OF WATER QUALT
ATTN: JOHN DORNEY, 4401 REEDY CREEK ROAD, RALEIGH, NC
27607. PLEASE PRINT OR T'Y'PE.
1. OWNER'S NAME: NCDOT
2. MAILING ADDRESS: P.O. Box 1587
SUBDIVISION NAME N/A
CITY. Greenville STATE: N.C. ZIP CODE: 27835
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
Greene Counri, S.R. 1211, .5 miles fTOm S.R. 1210
3. TELEPHONE NUMBER: (HOME) N/A (WORK) 252.830-3490
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
Day Johnson (Division 2 Environmental Officer) 252-830-3490
5. LOCATION OF WORK (PROVIDE AM", PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE);
COUNTY: Greene - NEAREST TOWN: Conte=ea
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) Bridge # 2100 S.R.
1111, .5 miles fWm S.& 1210
6. IMPACTI:O OR TREAM/ItIVER: Cow Bunch RIVER BASIN: Neuse

7. (a) IS PROJECT L :pTER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY e VISTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WB-I lilt YES, EXPLAIN:
(b) IS THE ... ,? TED WITHW A NORTH CAROLINA DIVISION OF COASTAL
MANAG A )R ENVIRONMENTAL CONCERN (AEC)? NO
(c) IF THE PROJECT IS LOCATED WITHIII A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? N/A
r
(a) HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? NO IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND ANY
ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION): N/A
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
NO. IF YES, DESCRIBE ANTICIPATED WORK: N/A
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: N/A
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
NI!
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: EXCAVATION:
FLOODING: OTHER :
DRAINAGE : TOTAL ACRES TO BE IMPACTED:
(b) 0) STREAM CHANNEL TO BE IMPACTED BY TIM PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on normal high water contours): FT
AVERAGE DEPTH BEFORE: FT AFTER FT
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL. X_
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOOD1NG-.
OTHER:
11, IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? N/A WHAT IS THE MECTED POND SURFACE AREA? N/A
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY I 1 DRAWINGS ONLY)
Bridge # 21 Washed out due to Hurricane Floyd. To be replaced with. 2 (A 142" x 91" CMPA culverts.
Work will be accomplished tom each side of the washout. A backhoe and loader will be used.
13. PURPOSE OF PROPOSED WORK: To replace Bridge # 21 that was damaged beyond repair ftom
Hurricane Floyd.
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUSTBE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
Emergency Ration to replace a washed out bridRc from Hurricane Floyd. Work will be accomplished
from each side of the washout.
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND 'VICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING . ; OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING ENDANGERED OR. PECIES OR CRITICAL.
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTP.I 1Y SI3D PROJECT.
DATE CONTACTED: Faxed 12/29/1999
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESEVATION OFFICER,
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED Faxed
12/29/1999.

17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC
(STATE) LAND? YES (IF NO, 00 TO 16)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? NO
(b) IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE ? NO
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAOGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION W PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WETLANDS:
(a) WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES, AND
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38).
ALL STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON
THE MAP. MAP SCALES SHOULD BE I INCH EQUALS SO MET OF 1 INCH EQUALS 100 FEET
OF THEIR EQUIVALENT.
(b) IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PRODUCT.
(c) IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS
RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
(d) ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRM.
(e) WHAT IS LAND USE OF SURROUNDING PROPERTY? N/A
(f) IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? N/A
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OF AISECTION 404 CORPS OF ENGINEERS PERMIT,
2. EITHER TIDE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROL IN/! ,D QN OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVTTY?' WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROG
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OWNER'S/AGENT'S SI
(AGENT`S SIONA 6my
IF AUTHORMATIO# FROM
THE OWNER IS PROVIDED).
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