20101024 Ver 1_Application_20101010

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Office Use Only:
Corps action ID no.
DWQ project-no.
Form Version 1.3 Dec 10 2008
Pre-Construction M U tion C Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the
Corps:
®Section 404 Permit ? Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number. 3 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps? ? Yes ® No

I 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. El Yes ® No
I1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below. ? Yes ® No
I1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ®No
?2. Project Information
2a. Name of project: SR 1800, Leary Mills Road Over Un-Named Tributary of Clayroot Swamp Pitt County
2b. County: Pitt
2c. Nearest municipality / town: Greenville
2d. Subdivision name: N/A
$e. NCDOT only, T.I.P. or state
project no: 2.207411
3. Owner Information
3a. Name(s) on Recorded Deed: North Carolina Department of Transportation
3b. Deed Book and Page No. N/A
3c. Responsible Party (for LLC if
applicable): N/A
3d. Street address: 105 Pactolus Highway NC 33 P.O. Box 1587
:3e. City, state, zip: Greenville, NC 27835
3f. Telephone no.: 252-830-3490
3g. Fax no.: 252-830-3341
3h. Email address: [e-mail]
Page 1 of 10
PCN Form - Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ® Other, specify: Division 2 Environmental Officer
4b. Name: Jay B. Johnson
4c. Business name
(if applicable); North Carolina Depratment of Transportation
4d. Street address: P.O. Box 1587
4e. City, state, zip: Greenville, NC 27835
4f. Telephone no.: 252-830-3490
4g. Fax no.: 252-830-3341
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name: NIA
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:

Page 2.of 10
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): SR 1800,Leary Mills Road Over Un-Named Tributary of
Clayroot Swamp
Latitude: N 35.396623 Longitude: - W
1b. Site coordinates (in decimal degrees): 77.258284
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: N/A acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Un-Named Tributary of Clayroot Swamp, a Tributary of
proposed project: Swift Creek
2b. Water Quality Classification of nearest receiving water. C;Sw;NSW
2c. River basin: Neuse Middle Neuse 03020202
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:
SR 1800, Leary Mills Road is a paved secondary state highway. Woodlands and Agriculture dominate the landscape.
3b. List the total estimated acreage of all existing wetlands on the property:
135 Square Feet of 404 Wetland Impacts For The Pipe To Pipe Replacement.
3r.. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
60' This site is part of a longer adjacent stream system
3d. Explain the purpose of the proposed project:
Pipe To Pipe Replacement ; the existing pipe has deteoriated and needs replacing.
3e. Describe the overall project in detail, including the type of equipment to be used:
The Existing 64' x 42" CMP will be replaced with a Proposed 81"x 59"x64' CMAP. Excavators,Dump Trucks,and Crane
Trucks will be used for the Bridge To Pipe Replacement.
14. Jurisdictional Determinations
14a. 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:
4b. If the Corps made the jurisdictional determination, what type
? Preliminary ? Final
I
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Mike Sutton Other. NCDOT
d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
October,2010
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.
6. Future Project Plans
fia. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 3 of 10
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. Welland 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
I number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
temporary
W1 ®P ? T Fill Bottomland ® Yes ® Corps
50 Sq
ft
Hardwood Forest ? No ? DWQ .
.
W2 ® P ? T Fill Bottomland ® Yes ® Corps 20 Sq
ft

Hardwood Forest
? No
? DWQ .
.

W3 ®P ? T
Fill Bottomland ® Yes ® Corps
50 Sq. ft

Hardwood Forest
? No
?DWQ .
W4 ® P ? T Fill Bottomland ® Yes ® Corps
15 Sq
ft
Hardwood forest ? No ? DWQ .
.
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
I2g. Total wetland impacts 135 Sq. Ft.
I2h. Comments: 135 Sq. ft. (0.003 Acres) 404 Wetland Impacts
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.
I3a. 3b. 3c. 3d. 3e. 3f. 3g.
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)
j
S1 ®P ? T
Pipe Un-Named
Tributary of ® PER ? Corps
15'
4'
'Clayroot Swamp ? INT ® DWQ

S2 ®P ? T
Pipe Un-Named
Tributary of ® PER

?INT ? Corps

®DWQ
15'
0
Clayroot Swamp

.
S3 ®P ? T
Pipe Un-Named
Tributary of ® PER ? Corps
15'
4'
I cayroot swamp INT
? ® DWQ

S4 ®P ? T
Pipe Un-Named
Tributary of
® PER
El Corps
15'
0
Clayroot swamp ?INT ®DWQ
S5 ? P ? T El PER F1 Corps
I [3 INT ? DWQ
S6 ? P ? T E] PER El Corps
I ? INT ? DWQ
?.h. Total stream and tributary impacts 8 LF,
ili. Comments: 8 Linear Feet of Stream Impacts
Page 4 of 10
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
Temporary
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts
1 4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete 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
15f. Total None
5g. Comments: None
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
ISi. Expected pond surface area (acres):
I5j. Size of pond watershed (acres):
ISk. Method of construction:
I6. Buffer Impacts (for DWQ)
If project will impact a protected ripadan 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.
® Neuse ?Tar-Pamlico ? Other: None
lProject is in which protected basin? ? Catawba ? Randleman
b. 6c. 6d. 6e. 6f. 6g.
I Buffer impact
number- Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
T (T) impact required?
B1 ®P ? T Fill Un-Named Tributary of ? Yes 715 Sq. Ft. 485 Sq. Ft.
Clayroot Swamp ® No
B2 UP [J T Fill Un-Named Tributary of ? Yes 735 Sq. Ft. 485 Sq. Ft.
Clayroot Swamp ® No
B3 ®P ? T Fill Un-Named Tributary of ? Yes 705 Sq. Ft. 475 Sq. Ft.
_ Clayroot Swamp ® No
6h. Total buffer impacts
Gi. Comments: See Page 6-A For Total Buffer Impacts
Page 5 of 10
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
Temporary
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
411 Total open water impacts None
4g. Comments: None
5. Pond or Lake Construction
If and or lake construction proposed, then complete 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
1 P1
1 P2
i5L Total None
15g. Comments: None
15h. Is a dam high hazard permit required?
?Yes ? No If yes, permit ID no:
15i. Expected pond surface area (acres):
I5j. Size of pond watershed (acres):
15k. Method of construction:
16. 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.
® Neuse ?far-Pamlico ? Other: None
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)
,
Temporary
impact
required?
I
61 ®P ? T B4 Fill Un-Named Tributary of ? Yes 735 Sq. Ft. 465 Sq. Ft.
Clayroot Swamp ®No
E32 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts 2890 Sq. Ft. 1910 Sq. Ft.
6i. Comments: 71
Page So 10
PCN Form -Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation
13. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
There are 135 Sq. Ft. of 404 Wetland Impacts for this Project; Therefore,The Wetland Impacts have been minimized to the
greatest extent feasible, with just those impacts occurring for the pipe installation for the project
l lb. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Use of existina roadwav to ooerate construction eouioment: no eauioment will enter wetlands.
I, 2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
tai Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State? ? Yes ® No
I 2b. 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
? Permitee Responsible Mitigation
I3. Complete if Using a Mitigation Bank
I3a. Name of Mitigation Bank:
I3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In4ieu Fee Program
I4a. Approval letter from in-lieu fee program is attached. ? Yes
I4b. Stream mitigation requested: linear feet
I4c. If using stream mitigation, stream temperature: ? wane ? cool ?cold
I4d. Buffer mitigation requested (DWQ only): square feet
14e. Riparian wetland mitigation requested: acres
I4f. Non-riparian wetland mitigation requested: acres
I4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
?5. Complete if Using a Permittee Responsible Mitigation Plan
5a.
I If using a pennittee responsible mitigation plan, provide a description of the proposed mitigation plan.
i
Page 6 of 10
PCN Form -Version 1.3 December 10, 2008 Version,
i
3c. Comments:
4. Complete if Making a Payment to In4leu 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
I4f. Non-riparian wetland mitigation requested: acres
14g. Coastal (tidal) wetland mitigation requested: acres
I4h. Comments:
15. 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
I6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
I ? Yes ® 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.

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: None
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
per mittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
N/A
6h. Comments:
Page 7 of 10
PCN Form -Version 1.3 December 10, 2008 Version
I E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1 1. Diffuse Flow Plan
1a . Does the project include or is it adjacent to protected riparian buffers identified ® Yes ? No
within one of the NC Riparian Buffer Protection Rules?
1b . If yes, then is a diffuse flow plan included? If no, explain why.
Comments: Sheet flow through Vegetated Uplands and Special Sediment control
® Yes ? No
Fence will be used to treat Stormwater Runoff from the road. Roadside ditches will
have wattles installed to treat water before entering into the buffers; the roadside
ditches are vegetated and will treat stor mwater as well.
I2. Stormwater Management Plan
2a . What is the overall percent imperviousness of this project? N/A Roadway/Bridge Project %
I2b . Does this project require a Stormwater Management Plan? ® Yes ? No
I2c . If this project DOES NOT require a Stormwater Management Plan, explain why:
2d . If this project DOES require a Stor mwater Management Plan, then provide a brief, narrative description of the plan:
Sheet flow through Vegetated Uplands and Special Sediment control Fence will be used to treat Stormwater Runoff from
the road. Roadside ditches will have wattles installed to treat water before entering into the buffers; the roadside ditches
are vegetated and will treat stonmwater as well.
? Certified Local Government
2e . Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stor mwater Program

i ® DWQ 401 Unit
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

i ? Other. N/A
i
3c.
Has the approved Stormwater Management Plan with proof of approval been
? Yes ® No
i
attached?
4. DWQ Stormwater Program Review
? Coastal counties
? HQW
a. Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply): ? Session Law 2006-246
® Other: NPDES Permit
b. Has the approved Stormwater Management Plan with proof of approval been
attached? ? Yes ® No
!5. DWQ 401 Unit Stormwater Review
I
5a.
Does the Stormwater Management Plan meet the appropriate requirements?
? Yes ? No
Page 8 of 10
PCN Form -Version 1.3 December 10, 2008 Version
5b. Have all of the 401 Unit submittal requirements been met? ? Yes ? No
F. Supplementary Information
I1. Environmental Documentation (DWQ Requirement)
i
la. Does the project involve an expenditure of public (federal/state/local) funds or the ® 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 ? 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 E] No
Comments:
I2. Violations (DWQ Requirement)
I2a. 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)?
Qb.
I 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)
I
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)
0.a. 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
Page 9 of 10
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 ? Yes ® No
habitat?
5b . Have you checked with the USFWS concerning Endangered Species Act ? Yes ® No
impacts?
E] Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
On-Site Investigation
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?
i
On-Site Investigation
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
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
SHPO Website
8. Flood Zone Designation (Corps Requirement)
18a. Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No
I8b. If yes, explain how project meets FEMA requirements: Pipe designed to no-rise standards
I8c. What source(s) did you use to make the floodplain determination? FEMA FIRM Maps
Jay B. Johnson
( L ?L
December 7,
2010
Applicant/Agents Printed Name pli nU nt's Signature
" Date
(Agent's signature alid o ly
rf authorization letter from the applicant
rovided.
Page 10 of 10
PCN Form - Version 1.3 December 10, 2008 Version

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PITT COUNTY
SR 1800, LEARYMILLS ROAD OVER
UN-NAMED TRIBUTARY OF CLAYROOT SWAMP
EXISTING 42" CORRUGATED METAL PIPE
PROPOSED 81 "x 59" CMAP
GARDNERVILLE USGS QUAD MAP , W E
SHEET NUMBER 80-B -
OF THE SOIL SURVEY OF PITT COUNTY
FIRM PANEL 5600 K MIDDLE NE USE 03020201
MAP NUMBER 3720560000K NE USE RI VER BASIN (!
CLAYROOT SWAMP C;Sw;NSW OCTOBER 17, 2010
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X= 2519050.6070
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W 77^-IS'--29"groat.
1 I N35.396623 DEGREES
W 77.258284 DEGREES ?.
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PITT COUNTY
SR 1800, LEARY HILLS ROAD OVER
UN-NAMED TRIBUTARY OF CLAYROOT SWAMP
EXISTING 42" CORRUGATED METAL PIPE
PROPOSED 81 "x 59" (:MAP
GARDNERVILLE USGS QUAD MAP
SHEET NUMBER 80-B
OF THE SOIL SURVEYOFPITT COUNTY
FIRM PANEL 5600 K MIDDL F. NE USE 03020202
MAP NUMBER 3720560000K NE USE RI VER BASIN
CLAYROOT SWAMP C;Sw;NSW
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X= 2519050.6070
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W 77^45'--29"
N35.396623 DEGREES
W 77.258284 DEGREES
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PITT COUNTY
SR 1800, LEARYMILLS ROAD OVER
[IN--NAMED TRIB UTAR Y OF CLA YROOT SWAMP
EXISTING 42" CORRUGATED METAL PIPE
PROPOSED 81"x 59" CMAP
GARDNERVILLE USGS QUAD MAP
SHEET NUMBER 80-B
OF THE SOIL SURVEY OF PITT COUNTY
FIRM PANEL 5600 K MIDDLE NEUSE 03020202
MAP NUMBER 3720560000K NEUSE RIVER BASIN
C'LA YROOT SWAMP C; Sw; NSW OCTOBER 27, 2010
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k 2519050.6070
N 35^-13'-49"
W 77^-15'--29"
N 35 346623 DEGREES
W 77.258284 DEGREES
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