20100466 Ver 1_Application_20100607

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
la. Type(s) of approval sought from the Corps: ?X Section 404 Permit ? Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1c: Has the NWP or GP number been verified by the Corps? ? Yes ?X No
1d. Type(s) of approval sought from the DWQ (check all that apply):
Nx 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
N 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 ?X No For the record only for Corps Permit:

? Yes N 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 N No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below. Yes E] No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ?X Yes ? No
2. Project Information U
2a. Name of project: PRA-CAHA 10(2), NC 12 Improvements
2b. County: Dare JUN " f
2c. Nearest municipality / town: South Nags Head
2d. Subdivision name: n/a V1E11A\DSlJ10Si0R>„?;,
2e. NCDOT only, T.I.P. or state project no: n/a
3. Owner Information
3a. Name(s) on Recorded Deed: National Park Service
3b. Deed Book and Page No. n/a
3c. Responsible Party (for LLC if
applicable): Kevin Rose, Federal Highway Administration
3d. Street address: 21400 Ridgetop Circle
3e. City, state, zip: Sterling, VA 20166
3f. Telephone no.: 571-434-1541
3g. Fax no.: 571-434-1577
3h. Email address: [e-mail]
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PCN Form - Version 1.4 January 2009
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4. Applicant Information (if different from owner) _ .t
4a. Applicant is: ? Agent ? Other, specify:
4b. Name: Kevin Rose
4c. Business name
(if applicable): Federal Highway Administration
4d. Street address: 21400 Ridgetop Circle
4e. City, state, zip: Sterling, VA 20166
4f. Telephone no.: 571-434-1541
4g. Fax no.: 571-434-1577
4h. Email address: [e-mail]
5. AgentlConsultant Information (if applicable)
5a. Name: n/a
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:

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B. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax PIN or parcel ID): n/a
1 b. Site coordinates (in decimal degrees): Latitude: ?5 °10?p3$q Longitude: - -15.9j N% \
1c. Property size: 2,250 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: Roanoke Sound
2b. Water Quality Classification of nearest receiving water: SA/HQW
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:
The area surrounding NC 12 is the Cape Hatteras National Seashore, a natural vegetated area.
3b. List the total estimated acreage of all existing wetlands on the property: C-Njoa
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: c??q
3d. Explain the purpose of the proposed project:
The project will improve the conditions of existing NC 12.
3e. Describe the overall project in detail, including the type of equipment to be used:
The project includes resurfacing, replacement of 4 culverts at 3 locations, widening of the paved shoulders, and removal of existing impervious surface.
91
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
ro'ect (including all prior phases) in the past? ?X Yes ? No ? Unknown

Comments: requested on 11112109
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
? Preliminary ? Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Agency/Consultant Company: AH Environmental
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 past? ? Yes ? No ? Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ? Yes ?X No
6b. If yes, explain.
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PCN Form - Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check allthat apply):
? Wetlands r? Streams-tributaries f Buffers ?X 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
. number
Permanent (P) or
Temporary 2b.
Type of impact 2c.
Type of wetland 2d.
Forested 2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other) 2f.
Area of
impact
(acres)
W1 Choose one Choose one Yes/No -
W2 - Choose one Choose one Yes/No -
W3 - Choose one Choose one Yes/No
W4 - Choose one Choose one Yes/No -
W5 - Choose one Choose one Yes/NO
W6 - Choose one Choose one Yes/No
2g. Total Wetland Impacts:
21h. 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.
Stream impact
number
Permanent (P) or
Temporary (T) 3b.
Type of impact 3c.
Stream name 3d.
Perennial (PER) or
intermittent (INT)? 3e.
Type of
jurisdiction 3f.
Average
stream
width
(feet) 3g.
Impact
length
(linear
feet)
S1 - Choose one - -
S2 - Choose one -
S3 - Choose one - -
S4 - Choose one -
S5 - Choose one - -
S6 - Choose one - -
3h. Total stream and tributary impacts
3i. Comments:
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PCN Form - Version 1.4 January 2009
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4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any othei& open water of
the U.S. then individual) list all open water impacts below.
4a.
Open water
impact number
Permanent (P) or
Temporary 4b.
Name of waterbody
(if applicable) 4c.

Type of impact 4d.

Waterbody
type 4e. -

Area of impact (acres)
01 P Channel to Roanoke Sound Fill Estuary 0.016
02 P Channel to Roanoke Sound Fill Estuary 0.007
03 P Channel Fill Estuary 0.006
04 T Channels Other Estuary 0.035
4f. Total open water impacts 0.064
4g. Comments: culverts wi e e ace at 3 oca ions. iprap will placed a e culvert m e s an ou e s to pro ec agams a orma io o
scour holes, which are currently present. Temporary dewatering is necessary to replace the culverts.
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
P1 Choose one
P2 Choose one
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required? ? Yes ? No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. 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 an impacts require mitigation, then you MUST fill out Section D of this form.
6a. Project is in which protected basin? ? Neuse ? Tar-Pamlico ? Catawba ? Randleman ? Other:
6b.
Buffer Impact
number-
Permanent(P)or
Temporary 6c.
Reason for impact 6d.
Stream name 6e.
Buffer
mitigation
required? 6f.
Zone 1
impact
(square
feet 6g.
Zone 2
impact
(square
feet
B1 Yes/No
B2 - Yes/No
B3 - Yes/No
B4 - Yes/No
B5 - Yes/No
B6 - Yes/No
6h. Total Buffer Impacts:
6i. Comments:
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D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Culverts will be replaced in same location as the existing culvert, and were sized for the same hydraulic capacity after accommodating sinking them a
foot below the substrate level per NCDWQ
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Sedimentation of adjacent wetlands will be minimized through the use of filter bags. The area to be dewatered for construction was minimized.
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 Q No
21b. If yes, mitigation is required 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: Choose one
Type: Choose one
Type: Choose one Quantity:
Quantity:
Quantity:
3c. Comments:
4. Complete if Makin 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: Choose one
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.

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PCN Form - Version 1.4 January 2009
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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 g No
61b. 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:
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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 ? Yes X? No
within one of the NC Riparian Buffer Protection Rules?
1b. If yes, then is a diffuse flow plan included? If no, explain why.
? Yes ? No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 8%
2b. Does this project require a Stormwater Management Plan? 59 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, na rrative description of the plan:
2.03 acres of existing impervious surface will be removed in order to offset impacts from the new 3.4 acres of impervious surface from the widened
shoulders. The remained of the additional stormwaler will be treated through sheet flow as approximately 40% of the area has a 5% or less slope
com prised of mowed grass.
2e. Who will be responsible for the review of the Stormwater Management Plan? DWQ '
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? n/a
? Phase II
? NSW
3b. Which of the following locally-implemented Stormwater management programs El USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ?X No
attached?
4. DWQ Stormwater Program Review
NCoastal counties
?HQW
4a . Which of the following state-implemented stormwater management programs apply ?ORW
(check all that apply): ?Session Law 2006-246
?Other:

4b I
. Has the approved Stormwater Management Plan with proof of approval been
? Yes ? No
attached?

5. DWQ 401 Unit Stormwater Review
5a . Does the Stormwater Management Plan meet the appropriate requirements? ?X Yes ? No
5b . Have all of the 401 Unit submittal requirements been met?. ?X Yes ? No
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. PCN Form -Version 1.4 January 2009
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F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal/state/local) funds or the ?X Yes ? No
use of public (federal/state) land?
1b. 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 0 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.) Signed FONSI is attached. ?X Yes ? No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Welland Rules (15A NCAC 2H .1300), DWQ Surface Water or Welland Standards, ?Yes ?X 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.
n/a
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PCN Form - Version 1.4 January 2009
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5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or ? Yes ?X No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ?x Yes ? No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted. Raleigh
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Coordination with the Natural Resource Manager at the Cape Hatteras National Seashore, coordination with the North Carolina Department of
Environment and Natural Resources, and coordination with the USFWS.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ?X No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Information consultation with NMFS.
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 ?X 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?
Coordination with the Cultural Resource Manager at the Cape Hatteras National Seashore, coordination with the Slate Historic Preservation Office.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? Q Yes ? No
8b. If yes, explain how project meets FEMA requirements:
The entire project area is located in a 100-year floodplain, so an alternate site for the project is not available. Improvement will be made to an existing
facility, and material will be removed from the floodplain to offset the placement of additional material.
8c. What source(s) did you use to make. the floodplain determination?
A Statement of Findings for floodplain impacts was completed. A Coastal Zone Management federal consistency determination received concurrence
from the Division of Coastal Management.

Kevin S. Rose 06-04-2010 I
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization
letter from the applicant is provided.)
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