20101055 Ver 1_Application_20101221

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I0?Q55
APPLICATION for lk? 9' I eo
70
Major Development Perms "k,
past revised 12127106)
North Carolina DIVISION OF COASTAL MANAGEMENT
1. Primary Applicant/ Landowner Information
Business Name Project Name (if applicable)
North Carolina Department Of Transportation 8-4422 Beaufort 81 SR 1106, Tripp Road Over Blount's
Creek Beaufort County WBS Element 33695.1.1
Applicant 1: First Name MI Last Name
Jay B. Johnson
Applicant 2: First Name MI Last Name
If additional applicants, please attach an additional page(s) with names li sted.
Mailing Address
PO Box
City
State
1 1587 Greenville NC
ZIP Country Phone No. FAX No.
27835 1587 us 252-830-3490 ext. 248 252-830-3341
Street Address (if different from above) City State ZIP -
Email
[e-mail]
2. Agent/Contractor Information
Business Name
Agent/ Contractor 1: First Name MI Last Name
Agent/ Contractor 2: First Name MI Last Name
Mailing Address
I
I PO Box City State
ZIP Phone No.1
ext. Phone No. 2
- - ext.
FAX No. Contractor #
Street Address (d different from above) City ., Slate ZIP
Email
<Form continues on back>
Form DCM MP-1 (Page 2 of 5)
i ,
1
APPLICATION for
Major Development Permit
3. Project Location
County (can be multiple) Street Address State Rd. #
Beaufort SR 1105, Tripp Road
Subdivision Name city State Zip
Phone No. Lot No.(s) (if many, attach additional page with list)
- - ext_ , , ,
a. In which NC river basin is the project located? b. Name of body of water nearest to proposed project
Tar-Pamlico Blounrs Creek
c. Is the water body identified in (b) above, natural or manmade? d. Name the dosest major water body to the proposed project site.
®Natural ?Manmade ?Unknown Blount's Creek
e_ Is proposed work within city limits or planning jurisdiction? f. If applicable, list the planning jurisdiction or city limit the proposed
?Yes ®No work fails within.
None
4. Site Description
a. Total length of shoreline on the tract (ft.) b. Size of entire tract (sq.ft.)
120'(60' East and 60' West) NIA
c. Size of individual lot(s) d. Approximate elevation of tract above NH1N (normal high water) or
NWL (normal water level)
(if many lot sizes', pfease attach additional page with a list) 5.8' ?NHW or ®NWL
e. Vegetation on tract
Maintained Roadside Grasses
f. Man-made features and uses now on tract
Bridge
g. Identify and describe the existing land uses adjacent to the proposed project site.
Woodlands
h. How does local government zone the tract? i. Is the proposed project consistent with the applicable zoning?
i N/A. (Attach zoning compliance certificate, if applicable)
?Yes ?No [DNA
j. Is the proposed activity part of an urban waterfront redevelopment proposal? Yes ®No
k. Hasa professional archaeological assessment been done for the tract? If yes, attach a copy. Yes No NA
If yes, by whom? NCDOT HEU Archaerology and
Historic Architecture
1. Is the proposed project located in a National Registered Historic District or does it involve a Yes No NA
National Register listed or eligible property? .
<Fofm continues on next pages
m. (i) Are there wetlands on the site? ®Yes ?No
(ii) Are there coastal wetlands on the site? ®Yes ?No
(iii) If yes to either (i) or (ii) above, has a delineation been conducted? ®Yes ?No
(Attach documentation, if available)
it

Form DCM MP-1 (Page 3 of 5)
t
APPLICATION for
Major Development Permit
n. Describe existing wastewater treatment facilities.
NIA
o. Describe existing drinking water supply source.
N/A
p. Describe existing stone water management or treatment systems.
N/A
5. Activities and Impacts
a. Will the project be for commercial, public, or private use? Commercial Public/Government
?Private/Community
b. Give a brief description of purpose, use, and daily operations of the project when complete.
The Existing 91' Long by 30.6' Wide RC Floor on Timber Piles will be replaced with a 125' Long 21" Cored Slab Bridge .
c. Describe the proposed construction methodology, types of construction equipment to be used during construction, the number of each type
of equipment and where it is to be stored.
The Existing Bridge Will Be Removed and the Proposed Bridge will Be Installed. Typical Roadway Construction Equipment
Will Be Used, Including,But Not Limited To Tracked Excevators,Crane,Dump Trucks, Flat-Bed Trucks,Back-Hoes,And Boom
Trucks.
d. List all development activities you propose.
Bridge Replacement
e. Are the proposed activities maintenance of an existing project, new work, or both? Both
f. What is the approximate total disturbed land area resulting from the proposed project? 24,025 ®Sq.Ft or ?Acres
g. Will the proposed project encroach on any public easement, public accessway or other area Yes ?No NA
that the public has established use of? -
h. Describe location and type of existing and proposed discharges to waters of the state.
N/A
i. Will wastewater or stormwater be discharged into a wetland? Yes ®No NA
If yes, will this discharged water be of the same salinity as the receiving water? ?Yes ?No ?NA
j. Is there any mitigation proposed? Yes ONO NA
If yes, attach a mitigation proposal.
<Form continues on back>
6. Additional Information
In addition to this completed application form, (MP-1) the following items below, if applicable, must be submitted in order for the application
package to be complete. Items (a) - (0 are always applicable to any major development application. Please consult the application
instruction booklet on how to property prepare the required items below. .,
a. A project narrative.
b. An accurate, dated work plat (including plan view and cross-sectional drawings) drawn to scale. Please give the present status of the
proposed project. Is any portion already complete? If previously authorized work, clearly indicate on maps, plats, drawings to distinguish
between work completed and proposed.
c. A site or location map that is sufficiently detailed to guide agency personnel unfamiliar with the area to the site. ' .
r
Form DCM MP-1 (Page 4 of 5)
f
APPLICATION for
Major Development Permit
d. A copy of the deed (with state application only) or other instrument under which the applicant claims title to the affected properties.
e. The appropriate application fee. Check or money order made payable to DENR.
I. A list of the names and complete addresses of the adjacent waterfront (riparian) landowners and signed return receipts as proof that such
owners have received a copy of the application and plats by certified mail. Such landowners must be advised that they have 30 days in
which to submit comments on the proposed project to the Division of Coastal Management
Name Rudolph L. Rowe and Anna Rowe do Ben A. Hollowell
Phone No. 572 Old Blount's Creek Road Chocowinity, NC 27817 Parcel 6699
Address Afton E. Rowe and Joshephine Rowe
Name 1535 Tripp Road Blounts Creek, NC 27814 Parcel 4837
Phone No. Rowe Family Trust cJo Afton G. Rowe
Address 1641 Tripp Road Blounts Creek, NC 27814 Parcel 9014
Name Thelma Rowe Bennett.
Phone No. 48 Norman Road Blounts Creek, NC 27814 Parcel 6535
Address
g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, permittee, and issuing dates.
None
h. Signed consultant or agent authorization form, if applicable.
L Wetland delineation, if necessary.
j. A signed AEC hazard notice for projects in oceanfront and inlet areas. (Must be signed by property owner)
k. A statement of compliance with the N.C. Environmental Policy Act (N.C.G.S. 113A 1-10), if necessary. If the project involves expenditure
of public funds or use of public lands, attach a statement documenting compliance with the North Carolina Environmental Policy Act.
I understand that any permit issued in response to this application will allow only the development described in the application.
The project will be subject to the conditions and restrictions contained in the permit.
I certify that I am authorized to grant, and do in fact grant permission to representatives of state and federal review agencies to
enter on the aforementioned lands in connection with evaluating information related to this permit application and follow-up
monitoring of the project.
I further certify that the information provided in this application is truthful to the best of my knowledge.
Date October 22, 2010 Print Name -Betty A. Caldwell, PE
Signature
Please indicate application attachments pertaining to your proposed project.
®DCM MP-2 Excavation and Fill Information ®DCM MP-5 Bridges and Culverts
?DCM MP-3 Upland Development
?DCM MP-4 Structures Information
r,
r ?
FornS DCM MP-2
EXCAVATION and FILL
(Except for bridges and culverts)
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of the Joint
Application that relate to this proposed project. Please include all supplemental information.
Describe below the purpose of proposed excavation and/or fill activities. All values should be given in feet
Access Other
Channel Canal Boat Basin Boat Ramp Rock Groin Rock (excluding
(NLW or Breakwater shoreline
NWL stabilization
Length
Width
Avg. Existing

Depth NA NA
Final Project

Depth NA NA
1. EXCAVATION ®This section not applicable
a. Amount of material to be excavated from below NHW or NWL in b. Type of material to be excavated.
cubic yards.
c. (i) Does the area to be excavated include coastal wetlands/marsh
(CW), submerged aquatic vegetation (SAV), shell bottom (SB),
or other wetlands (WL)7 If any boxes are checked, provide the
number of square feet affected.
?CW ?SAV ?SB _
?WL ?None
(ii) Describe the purpose of the excavation in these areas:
d. High-ground excavation in cubic yards.
2. DISPOSAL OF EXCAVATED MATERIAL ®This section not applicable
a. Location of disposal area. b. Dimensions of disposal area.
c. (i) Do you claim title to disposal area?
?Yes ?NO ?NA
(ii) If no, attach a letter granting permission from the owner.
d. (i) Will a disposal area be available for future maintenance?
?Yes ?No ?NA
(ii) If yes, where?
e. (i) Does the disposal area include any coastal wetlands/marsh
(CW), submerged aquatic vegetation (SAV), shell bottom (SB),
or other wetlands (WL)? If any boxes are checked, provide the
number of square feet affected.
?CW ?SAV ?SB
?WL ?None
(ii) Describe the purpose of disposal in these areas:
f. (1) Does the disposal include any area in the water?
?Yes ?No ?NA
(ii) If yes, how much water area is affected?
Form DCM MP-2 (Excavation and Fill, Page 2 of 2)
3. SHORELINE STABILIZATION ?This section not applicable
(If development is a wood groin, use MP-4 - Structures)
a. Type of shoreline stabilization:
[]Bulkhead MRiprap []Breakwater/Sill []Other.
c. Average distance waterward of NHW or NWL: 0
e. Type of stabilization material:
Granite
g. Number of square feet of fill to be placed below water level.
Bulkhead backfill _ Riprap 0
Breakwater/Sill Othe r
i. Source of fill material.
b. Length: 120' (60' East And 60' West)
Width: 6'-10'
d. Maximum distance waterward of NHW or NWL: 0'
f. (i) Has there been shoreline erosion during preceding 12
months?
[]Yes ®No ?NA
(ii) If yes, state amount of erosion and source of erosion amount
information.
h. Type of fill material.
Granhel
4. OTHER FILL ACTIVITIES ®This section not applicable
(Excluding Shoreline Stabilization)
a. (i) Will fill material be brought to the site? []Yes ?No ?NA b. (i) Will fill material be placed in coastal wetlands/marsh (CW),
If yes,
(ii) Amount of material to be placed in the water
(iii) Dimensions of fill area
(iv) Purpose of fill
submerged aquatic vegetation (SAV), shell bottom (SB), or
other wetlands (WL)? If any boxes are checked, provide the
number of square feet affected.
?CW ?SAV _ ?SB
?WL []None
(ii) Describe the purpose of the fill in these areas:
5. GENERAL
a. How will excavated or fill material be kept on site and erosion b. What type of construction equipment will be used (e.g., dragline,
controlled? backhoe, or hydraulic dredge)?
Silt Fences and Rip Rap Typical Road and Bridge Construction Equipment
C. (1) Will navigational aids be required as a result of the project?
[]Yes ONo ?NA
(ii) If yes, explain what type and how they will be implemented.
d. (i) Will wetlands be crossed in transporting equipment to project
site? []Yes ONo ?NA
(ii) If yes, explain steps that will be taken to avoid or minimize
environmental impacts.
October 22, 2010
Date Betty A. Caldwell, PE
8-4422 Beaufort 81 SR 1106, Tripp Road Over Blount s Applicant ame
Creek,Bddge To Bridge Replacement WBS Element Number; [?
33695.1.1
Applicant Signal re
Project Name "''

F®rMDCE MP-5
BRIDGES and CULVERTS
i
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of the Joint
Application that relate to this proposed project. Please indude all supplemental information.
1. BRIDGES ?This section not applicable
a. Is the proposed bridge: b. Water body to be crossed by bridge:
?Commercial ®PubliciGovemment ?Private/Community . Blount's Creek
c. Type of bridge (construction material):
Proposed 21" Cored Slab Bridge .
e. (i) Will proposed bridge replace an existing bridge? ®Yes ?No
If yes,
(ii) Length of existing bridge: 91'
(iii) Width of existing bridge: 30.6' Out to Out
(iv) Navigation clearance underneath existing bridge: 6_2'
(v) Will all, or a part of, the existing bridge be removed?
(Explain) All of the Existing Bridge will be Removed
d. Water depth at the proposed crossing at NLW or NWL:
2.9'
f. (i) Will proposed bridge replace an existing culvert? ?Yes ONO
If yes,
(i) Length of existing culvert: _
(iii) Width of existing culvert:
(iv) Height of the top of the existing culvert above the NHW or
NWL:
(v) Will all, or a part of, the existing culvert be removed? -
(Explain)
9. Length of proposed bridge: 125'
h. Width of proposed bridge: 28'
i. Will the proposed bridge affect existing water flow? ?Yes ONO j. Will the proposed bridge affect navigation by reducing or
If yes, explain: increasing the existing navigable opening? ?Yes ONO
If yes, explain:
k. Navigation clearance underneath proposed bridge: 6_2 I. Have you contacted the U.S. Coast Guard concerning their
approval? ?Yes ONO
If yes, explain:
m. Will the proposed bridge cross wetlands containing no navigable n. Height of proposed bridge above wetlands: 4_5
waters? ?Yes ONO
If yes, explain:
2. CULVERTS ®This section not applicable
a. Number of culverts proposed: b. Water body in which the culvert is to be placed:
< Form continues on back>
ii .
Form HDGM MP-5 (Bridges and Culverts, Page 2 of 4)
c. Type of culvert (construction material):
d. (i) Will proposed culvert replace an existing bridge? e. (i) Will proposed culvert replace an existing culvert?,
?Yes ?No ?Yes ?No
If yes,
(ii) Length of existing bridge:
(ii) Width of existing bridge: _
(iv) Navigation clearance underneath existing bridge:
(v) Will all, or a part of, the existing bridge be removed?
(Explain)
If yes,
(ii) Length of existing culvert(s):
(iii) Width of existing culvert(s):
(iv) Height of the top of the existing culvert above the NHW or
NWL:
(v) Will all, or a part of, the existing culvert be removed?
(Explain)
f. Length of proposed culvert:
h. Height of the top of the proposed culvert above the NHW or NWL
j. Will the proposed culvert affect navigation by reducing or
increasing the existing navigable opening? ?Yes ?No
If yes, explain:
9. Width of proposed culvert:
I. Depth of culvert to be buried below existing bottom contour.
k. Will the proposed culvert affect existing water flow?
?Yes ?No
If yes, explain:
3. EXCAVATION and FILL ?This section not applicable
a. (i) Will the placement of the proposed bridge or culvert require any
excavation below the NHW or NWL? ®Yes ?No
If yes,
(ii) Avg. length of area to be excavated: 35'
(iii) Avg. width of area to be excavated: 20'
(iv) Avg. depth of area to be excavated: 4'
(v) Amount of material to be excavated in cubic yards: 104
cods
to. (i) Will the placement of the proposed bridge or culvert require any
excavation within coastal wetlands/marsh (CW), submerged
aquatic vegetation (SAV), shell bottom (SB), or other wetlands
(WL)? If any boxes are checked, provide the number of square
feet affected.
?CW ?SAV ?SB
?WL ®None
(ii) Describe the purpose of the excavation in these areas:
c. (i) Will the placement of the proposed bridge or culvert require any
high-ground excavation? ®Yes ?No
If yes,
(ii) Avg. length of area to be excavated: 15'
(iii) Avg. width of area to be excavated: 20'
(iv) Avg. depth of area to be excavated: 2'
(v) Amount of material to be excavated in cubic yards: 22 cods

Form DCM MP-5 (Bridges and Culverts, Page 3 of 4)
d. If the placement of the bridge or culvert involves any excavation, please complete the following:
(i) Location of the spoil disposal area: Temporary Spoil Area is in the Existing Road
(ii) Dimensions of the spoil disposal area: 100' x 200'
(iii) Do you claim title to the disposal area? ®Yes ?No (If no, attach a letter granting permission from the owner.)
(iv) Will the disposal area be available for future maintenance? ®Yes ?No
(v) Does the disposal area include any coastal wetlandstmarsh (CW), submerged aquatic vegetation (SAVs), other wetlands (WL), or shell
bottom (SB)?
?CW ?SAV ?WL ?SB ®None
If any boxes are checked, give dimensions if different from (ii) above.
(vi) Does the disposal area include any area below the NNW or NWL? ? ?Yes ®No
If yes, give dimensions if different from (ii) above.
e. (i) Will the placement of the proposed bridge or culvert result in any f.
fill (other than excavated material described in Item d above) to
be placed below NHW or NWL? ?Yes ®No
If yes,
(ii) Avg. length of area to be filled:
(iii) Avg. width of area to be filled:
(iv) Purpose of fill:
(i) Will the placement of the proposed bridge or culvert result in any
fill (other than excavated material described in Item d above) to
be placed within coastal wetlands/marsh (CW), submerged
aquatic vegetation (SAV), shell bottom (SB), or other wetlands
(WL)? If any boxes are checked, provide the number of square
feet affected. _
®CW 35 So. Ft. ?SAV ?SB _
OWL 1075 So. Ft. ?None
(ii) Describe the purpose of the excavation in these areas:
Fill for Shoulders
g. (i) Will the placement of the proposed bridge or culvert result in any
fill (other than excavated material described in Item d above) to
be placed on high-ground? ?Yes ®No
If yes,
(ii) Avg. length of area to be filled:
(iii) Avg. width of area to be filled:
(iv) Purpose of fill:
a. Will the proposed project require the relocation of any existing b. Will the proposed project require the construction of any temporary
utility lines? ®Yes ?No detour structures? ?Yes ®No
if yes, explain: 8" HDPE Water Line to be Installed by If yes, explain:
Directional Bore North Side 2" Dud for Telephone
Cable by Directional Bore South Side
If this portion of the proposed project has already received
approval from local authorities, please attach a copy of the
approval or certification.
< Form continues on back>

form DCPA 11AP-5 (Bridges and Culverts, Page 4 of 4)
c. Will the proposed project require any work channels? I d. How will excavated or fill material be kept on site and erosion
?Yes ®No controlled?
If yes, complete Form DCM-MP-2. Turbidity Curtains and Silt Fences will be used to retain
sediment on-site
e. What type of construction equipment will be used (for example,
dragline, backhoe, or hydraulic dredge)?
Typical Bridge Construction Equipment
g. Will the placement of the proposed bridge or culvert require any
shoreline stabilization? ®Yes ?No
If yes, complete form MP-2, Section 3 for Shoreline
Stabilization only.
f. Will wetlands be crossed in transporting equipment to project site?
?Yes ®No
If yes, explain steps that will be taken to avoid or minimize
environmental impacts.
October 22,2010 WBS Element 33695.1.1 Debit $400
Date
B-4422 Beaufort 81 SR 1106,Tripp Road Over Blount's Creek,
Bridge to Bridge Replacement, Beaufort County WBS Element
Number 45298.1.1
Project Name
Betty A. Caldwell, PE
j
c'
Applicant Sig lure
' O?0F W AT eq.q
1 I >
I?®?I O T
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification C Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the
Corps:

Section 404 Permit [:1 Section 10 Permit
I
1 b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ? Yes ® No
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
I a. 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
If. 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 ® No
1g, Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below. ® Yes ? No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? M Yes ? No
2. Project Information

2a.
Name of project: B-4422 Beaufort 81 Bridge To Bridge Replacement SR 1106, Tripp Road Over
Blount's Creek
WBS Element Number 33695.1.1
2b. County: Beaufort
2c. Nearest municipality / town: Blount's Creek
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
project no: 33695.1.1
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 11.
PCN Form -Version 1.3 December 10, 2008 Versiori -
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: N/A
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): B-4422 Beaufort 81 SR 1106, Tripp Road Over Blount's
Creek
Latitude: N 35.359045 Longitude: - W
1b. Site coordinates,(in decimal degrees): 76.966833
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: N/A acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Blount's Creek, a Tributary of Pamlico River
proposed project:
2b. Water Quality Classification of nearest receiving water. C;Sw;NSW
2c. River basin: Tar-Pamlico
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 1106, Tripp 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:
35 Square Feet of Coastal Wetland Impacts and 1075 Sq. ft. of 404 Wetland Impacts For The Bridge To Bridge
Replacement.
3c. 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:
Bridge To Bridge Replacement ; the existing bridge has deteoriated and needs replacing.
3e. Describe the overall project in detail, including the type of equipment to be used:
The Existing 91' Long RC Floor on Timber Pilings Bridge will be replaced with a Proposed 125' Long 21 Cored Slab
Bridge. Excavators, Dump Trucks,and Crane Trucks will be used for the Bridge To Bridge Replacement.
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:
4b. If the Corps made the jurisdictional determination, what type ? preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Stephen Lane, NCDCM Jay Other. NCDCM and NCDOT
Johnson,NCDOT
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
February 12, 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.
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.
C. Proposed Impacts Inventory
1. Impacts Summary
I 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)
Temporary
W1 ®P ? T Fill Bottomland ® Yes ® Corps 280 Sq. Ft.
Hardwood Forest ? No ? DWQ
W2 ®P ? T Fill Bottomland Yes M Corps
Hardwood Forest ? No ? DWQ
W3 ®P ? T Fill Bottomland ® Yes ® Corps 475 sq. Ft.
Hardwood Forest E] No El DWQ
W4 ®P ? T Fill Bottomland ® Yes ® Corps 285 Sq. Ft.
Hardwood Forest ? No ? DWQ
W5 ? PEI T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts 1075 Sq. Ft.
2h. Comments: 1075 Sq. Ft. (0.02 Acres) of 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.
3a. 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 M (INT)? other) (feet) feet)
S1 ®P ? T Pilings in Stream Blount's Creek ® PER
? INT ? Corps
® DWQ 65' 42 Sq. Ft.
S2 ®P ? T Pilings in Stream Blount's Creek ® PER
? INT El Corps
® DWQ 65' 52 Sq. Ft.
S3 ® P ? T Pilings in Stream Blount's Creek ® PER
? INT ? Corps
® DWQ 65' 54 Sq. Ft.
S4 ® P ? T Pilings in Stream Blount's Creek ® PER
? INT ? Corps
® DWQ 65' 50 Sq. Ft.
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts 198 Sq.
Ft.
3i. Comments: 198 Square Feet of Stream Impacts
Page 5 of 11
PCN Forth - 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
4E Total open water impacts None
4g. Comments: No Open Water Impacts
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Welland 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
5L Total None
5g. Comments: None
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.
? Neuse ®Tar-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?
B1 ®P ? T Fill Blount's Creek ® Nos 550 Sq. Ft. 445 Sq. Ft.
B2 ®P ? T Fill Blount's Creek ® Nos 590 Sq. Ft. 405 Sq. Ft.
B3 ®P ? T Fill Blount's Creek ® Nos 600 Sq. Ft. 425 Sq. Ft.
6h. Total buffer impacts
6i. Comments: See Page 6-A For Total Buffer Impacts
Page 6 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
Temporary
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts None
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
5f. Total None
5g. Comments: None
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.
? Neuse ®Tar-Pamlico ? Other: No
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?
B1 ®P ? T B 4 Fill Blount's Creek ® Nos 710 Sq. Ft. 405 Sq. Ft.
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts 2450 Sq. Ft. 1680 Sq. Ft.
6i. Comments:
Page3 f!O
PCN Form -Version 1.3 December 10, 2008 Version
6-
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.,
There are 1075 Sq. Ft. 404 Wetland Impacts for this Project and 35 Sq. ft.of Coastal Wetland Impacts; However, There are
2450 Square Feet of Buffer Zone 1 Impacts and 1680 Sq. Ft. of Buffer Zone 2 Impacts due to the installation of a Longer
Bridge to Replace the Existing Bridge. The Wetland Impacts have been minimized to the greatest extent feasible.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Use of existing roadway to operate construction equipment; no equipment will enter wetlands.
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 ® No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation option will be used for this

pro
project? ? Mitigation bank

E] Payment to in-lieu fee program

? Pennittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
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:
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.
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: None
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
pennittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
WA
6h. Comments:
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
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: Storm Water will diffuse flow through vegetated uplands before entering
® Yes ? No
wetlands. there are no Weep Holes on the Proposed Bridge, and stormwater is
treated at the outlet pipe at Station 16+80 with Rock Inlet Sediment traps, Type C.
Stormwater will filter and diffuse flow through Special Sediment Control Fence.
2. Stormwater Management Plan
2a . What is the overall percent imperviousness of this project? N/A Roadway/Bridge Project %
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 Stor mwater Management Plan, then provide a brief, na rrative description of the plan:
Storm Water will diffuse flow through vegetated uplands before entering wetlands. there are no Weep Holes on the
Proposed Bridge, and stormwater is treated at the outlet pipe at Station 16+80 with Rock Inlet Sediment traps, Type C.
Stormwater will filter and diffuse flow through Special Sediment Control Fence.
? 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 Stor mwater 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 .
? USMP
apply (check all that apply): ? Water Supply Watershed
? Other: N/A
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ® No
attached?
4. DWQ Stormwater Program 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: NPDES Permit
4b. 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? ? Yes ? No
Page 9of11 , .•,
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
1. Environmental Documentation (DWQ Requirement)
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
? Yes ? No
letter.)
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 213 .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 discha rge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
N/A
Page 10 of 11
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?
?
Raleigh
Sc. 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?
Mr.Travis Wilson, NCWRC
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?
Mr. Travis Wilson, NCWRC
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 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?
NCDOT HEU Historic Architecture and Archaeology
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: Bridge designed to no-rise standards
8c. What source(s) did you use to make the floodplain determination? FEMA FIRM Maps
Betty A. Caldwell, &1
-dav October 22,
? 2010
Applicant/Agent's Printed Name A plicantlAgent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)
Page 11 of 11
PCN Form -Version 1.3 December 10, 2008 Version
RE Beaufort 81 Moratorium B4422.txt
From: Wilson, Travis W.
Sent: Friday, October 01, 2010 2:49 PM
To: Sutton, Michael W
Subject: RE: Beaufort 81 84422
1 apologize for missing your first email, but WRc does not request an in water work
moratorium for this bridge replacement.
-----Original Message-----
From: Sutton, Michael W
Sent: Thursday, September 30, 2010 11:34 AM
To: Wilson, Travis W. ..
Cc: Rogerson, Maria A; Johnson, lay B; Jones, Larry L; Tran, van K; Alligood, Dwayne
H
Subject: FW: Beaufort 81 B4422
Good Morning Mr. Travis.... we would like to know if there is a moratorium in the
Beaufort 81, B-4422 Location... Many Thanks.... mike -----original Message-----
From: Sutton, Michael w
sent: Wednesday, September 29, 2010 2:50 PM
To: Rogerson, Maria A ([e-mail])
Subject: FW: Beaufort 81 84422
-----Original Message-----
From: Sutton, Michael W
sent: Thursday, September 02, 2010 4:31 PM
To: Travis Wilson ([e-mail])
Cc: Jay B. Johnson ([e-mail])
subject: Beaufort 81 B4422
Hey Mr. Travis.... Division 2 plans to replace Beaufort 81,B-4422 SR 1106,Tripp Road
Over Blount's Creek. we would like to know if this location has a moratorium.
Attached are maps for your use in determinations. Thank You.... mike
Email correspondence to and from this sender is subject to the H.C. Public Records
Law and may be disclosed to third parties.
Project TrachngpNo. (hepmal Use)
10'00-0010
NO SURVEY REQUIRED FORM
PROJECT INFORMATION
Project No: 2B.200711 County: Beaufort
WBS No: 2B.200711 Document:
F. A. No: BRZ-1106(1) Funding: ? State ® Federal
Federal (USACE) Permit Required? ® Yes ? No Permit Type: NWP 3 and CAMA GP
Project Description: Replace the existing timber bridge with a proposed 127 foot long cored slab Bridge
on SR 1106 Tripp Road] over Blounts Creek. 1
SUMMARY OF CULTURAL RESOURCES REVIEW
Briefdescription ofreview activities, results ofreview, and conclusions:
Review of HPO quad maps, historic designations roster, and indexes was undertaken on 8/26/10. Based
on this review, there are no existing NR properties in the Area of Potential Effects. No cultural resource
properties appear to be present in the project APE.
Brief Explanation of why the available information provides a reliable basis for reasonably predicting
that there are no unidentified historic properties in the APE:
The new bridge will replace the old bridge in the existing extensive embankments with no impact outside
of the current right of way. An off-site detour will be utilized during construction.
SUPPORT DOCUMENTATION
See attached: Map(s), Previous Survey Info, Photos, Correspondence, Photocopy of notes from county
survey.
FINDING BY NCDOT CULTURAL RESOURCES PROFESSIONAL NO SURVEY REQUIRED
ARCHAEOLOGY HISTORIC ARCHITECTURE (CIRCLE ONE)
Resources Specialist
-No Survey Required "form far Minor Tmotporiatian Projects as Qrmlhed in the 1007 Anramnwdc Agreement.
NCDOTArchaeologv & Historic Archilecove Grosses

Late
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UNITED STATES
1EPARTMENIl OF THE INTERIOR
GEOLOGICAL SURVEY
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NO HISTORIC PROPERTIES PRESENUAFFECTED FORM
Project Tmcking No. (Iniemal Use)
10-08-0010
PROJECT INFORMATION
Project No: B-4422 County: Beaufort
WBSNo: 33695.1.1 Document: CE
F.A. No: BRZ-1106(l) Funding: ? State ® Federal
Federal (USACE) Permit Required? ® Yes ? No Permit Type: NWP 3 & CAMA GP
Project Description:
Replace Bridge No. 81 over Blounts Creek on SR 1106 (Tripp Rd).
SUMMARY OF FINDINGS
The North Carolina Department of Transportation (NCD07) reviewed the subject project and determined:
? There are no properties over fifty years old within the project's area of potential effects.
® There are no properties less than fifty years old which are considered to meet Criteria Consideration G
within the project's area of potential effects.
® There are no National Register-listed or Study Listed properties within the project's area of potential
effects.
® All properties greater than 50 years of age located in the APE have been considered and all compliance
for historic architecture with Section 106 of the National Historic Preservation Act and GS 121-12(a) has
been completed for this project.
® There are no historic properties present or affected by this project. (Attach any notes or documents as
needed)
"No Nletortc Pmpenies Pmsent"farm forUmor Trmaponmim Pmjecn m Quatfed w the 2006 Progmmmatic Agreemem.
NCDOTArchmolaV & Historic Architecture Groups -
SUMMARY OF CULTURAL RESOURCES REVIEW
Brief description ofreview, activities, results of review, and conclusions:
Review of HPO quad maps, historic designations roster, and indexes was undertaken on September 13,
2010. Based on this review, there were no existing NR, SL, LD, DE, or SS properties in the Area of
Potential Effects. Beaufort County GIS and Tax Parcel Data indicated a farm with a house and
outbuildings near the APE. A site visit was conducted on September 16, 2010.
A house surrounded by outbuildings is located at the north end of a large field of cotton. The house was
constructed in 1929, is a basic I-house plan with a rear side gable addition. The house has been sided
with vinyl, the windows and their surrounds have been replaced as have the porch columns and one of:
the exterior chimneys. The other structures include the former living quarters, two mule sheds,
smokehouse, privy, and tobacco barn. Most of the outbuildings are in deteriorated condition.
Additionally there is a family cemetery on the property that includes approximately fifty headstones
dating from 1891 to present day. This farm complex is sited approximately 1500 feet from the bridge.:
Due to this distance no historic properties will be affected by the bridge replacement project. I
SUPPORT DOCUMENTATION
See attached: Map and Photographs.
Signed:
C1 /Z-347-010'.
Cultural Resource S cialis CDOT Date
Representative, HPO Date
HPO/OSA Comments:
f
u
"No Huron Properties Pmmf fo m far MB Tr ponxion Projem w Qudied m the 2W6 Programmok Agreement
NCD0TArdM1 v&V& Nirtmc Archiremre Groups
i
B-4422 BEA UFOR T 81
BRIDGE TO BRIDGE REPLACEMENT
SR 1106, TRIPPROAD OVER BLOUNTS CREEK
EDWARD USGS QUAD MAPAND SHEET NUMBER 17
OF THE SOIL SUR VEY OF BEA UFOR T COUNTY
REPLACE EXISTING 91'LONG BY30.6'(OUT TO OUT) TIMBER BRIDGE
WITHA 127'LONG BY27'-10" CLEAR ROAD WAY CORED SLAB BRIDGE
WBS ELEMENT NUMBER 33695. 1.1 MAP NUMBER 3720650900 J
BLOUNTS CREEK C;Sw;NSW AUGUST 19, 2010
PAMLICO 03020104 FIRM PANEL 6509 J
TAR-P,aMLICO BASIN
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B-4422 BEA UFORT 81
BRIDGE TO BRIDGE REPLACEMENT
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EDWARD USGS QUAD MAPAND SHEET NUMBER 17
OF THE SOIL SURVEY OF BEA UFORT COUNTY
REPLACE EXISTING 91'LONG BY30.6'(OUT TO OUT) TIMBER BRIDGE
WITHA 127LONG BY27'--10" CLEAR ROADWAY CORED SLAB BRIDGE
WBS ELEMENT NUMBER 336 MAP NUMBER 3720650900 J
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