20090389 Ver 1_Application_20110228

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SR 1711, Worthington Road, Pitts
County Pipe Extensions '
All Planning documents have been completed including the Programmatic Categorical Exclusion Form
Regulatory Authorization Options for this Activity
Federal: Section 404(F)(1)(b) Exempt Activities-Maintenance of Transportation Structures.
Action 1D Number SAW-2005-10677
State: Activities Deemed to Comply with Water Quality Standards.
Local: None
Or
Federal: USACE Nationwide General Permit 3 - Maintenance
Action ID Number SAW-2005-10677
State: General Water Quality Certification #3687
Local: None
Proiect Description
09 - G3*9qu.Z
The Project consists of Extending the existing 36" x 50' CMP with 10' extensions on each end of the
existing pipes. This will allow construction of a wider and safer shoulder. Class B stone will be placed on
the slopes for slope protection and the shoulder will be seeded as soon as possible.
In order to ensure compliance with best management practices, all attached General and Regional
Conditions associated with Nationwide Permit 3 and Water Quality Certification #3687 must be followed.
Keep demolition and construction debris out of the stream. Riprap will not be placed below the
plane of ordinary high water for stabilization. Excavation should be confined to the right of way,
and limited to the minimum amount required to excavate in high ground for the construction of the
new bridge. All excavated material should be removed from the site, placed on existing spoil piles, or
disposed of in farm fields. Any waste material disposed of off-site shall have a reclamation plan.
All Erosion and Sedimentation measures and Maintenance Best Management Practices should be
implemented. I am forwarding a copy to Mr. Andy Blankenship in Roadside Environmental for his perusal
in E&S inspections. The project supervisor should always have this permit package, including the attached
General and Regional Conditions associated with the Nationwide Permit 3 and Water Quality Certification
#3687 on site during the bridge replacement. The project supervisor should notify me immediately if any
questions or concerns should arise before and during construction.
Jay B. Johnson
Division 2 Environmental Officer
[phone]
William SR 1711 Worthington Road Pitt County.txt
From: Wescott, William G SAW [[e-mail]
Sent: Friday, July 24, 2009 9:31 AM
To: Sutton, Michael W
Subject: FW: SR 1711, Worthington Road, Pitt County
Mike,
As per our conversation regarding SR 1711 (Worthington Road), it is acceptable to
use two pipes instead of one pipe.
william
----- original Message-----
From: Wescott, William G SAW
Sent: Tuesday, March 17, 2009 11:36 AM
To: 'Sutton, Michael w'
Subject: RE: SR 1711, Worthington Road, Pitt County
Mike,
I have reviewed the information you sent regarding pipe replacements on SR
1711, Worthington Road, Pitt County and the project fits a non-reporting
Nationwide Permit #3. Print out the Terms & Conditions for NWP#3 and you
will be covered as far as the uSACE is concerned. Also print out this email
for your records because i will not be sending out a tear sheet for the
non-reporting NWP#3.
William
---original Message-----
From: Sutton, Michael W [mailto:[e-mail]]
sent: Friday, March 13, 2009 3:01 PM
To: Wescott, William G SAW
Subject: SR 1711, Worthington Road, Pitt County
Hey Mr. william... There are 2 pipe replacements on SR 1711,worthington Road,
Pitt County and i would like to get verification that we can replace these
pipes under a NWP 3 for this project. Attached are maps for your use. There
are no 404 wetland impacts. Thanks...mike
Email correspondence to and from this sender is subject to the N.C. Public
Records Law and may be disclosed to third parties.
Page 1
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. 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 ? Yes ? Corps
? No ? DWQ
W2 ? P ? T ? Yes ? Corps
? No ? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? PEI T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts 0 Sq. Ft.
2h. Comments: 0 Sq. ft. 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 (T) (INT)? other) (feet) feet)
S1 ®P ? T Pipe Extensions
02/23/2011 U/r Fork Swamp ® PER
? INT ? Corps
® DWQ 30' 20'
S2 ? P ? T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P r-1 T E] PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts 20 LF
3i. Comments: 20 Linear Feet of Stream Impacts for Pipe Extensions 02/23/2011
Page 4 of 10
PCN Form - Version 1.3 December 10, 2008 Version
O?WAT\Fd\OG
oNi?7 <
Office Use Only:
Corps action ID no.
DWO project no.
Forth Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1a . Type(s) of approval sought from the
Corps:
X Section 404 Permit E] Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number. 3 or General Permit (GP) number.
1c. Has the NAP or GP number been verified by the Corps? X 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 X 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:
X Yes No For the record only for Corps Permit:

? Yes X 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 X No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. XYes ? No
th. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes XNo
2. Project Information
2a. Name of project: SR 1711, Worthington Road Pipe Number 2
2b. County: Pitt
2c. Nearest municipality / town: Winterville
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
project no: 40466
3. Owner Information
3a. Name(s) on Recorded Deed:
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 11
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: X Agent ? Other, specify:
4b. Name: Jay B. Johnson
4c. Business name
(if applicable):
North Carolina Department of Transportation
4d. Street address: P.O. Box 1587
4e. City, state, zip: Greenville, NC 27835
4f. Telephone no.: 252-8303490
4g. Fax no.: 252$303341
4h. Email address:
5. Agent(Consultant Information (if applicable)
5a. Name:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 11
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): - SR 1711, Worthington Roade Pipe Extensions
Latitude: N 35.531839_ Longitude: - W
1b. Site coordinates (in decimal degrees):. 77.322305 -

.. (DD.ODDDDD) - (-DD.DDDDDD)
1c. Property. size:. WA acres..
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Indian Well swamp
proposed project:
2b. Water Quality Classification of nearest receiving water: C;Sw;NSW
2c. River basin: Neuse
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinityof the project at the time of this
application: - -
SR 1711, Worthington Road is a paved secondary state highway. Single Family. Homes;D.H. Conley High School,and
Agriculture are the,primary land uses.
3b. List the total estimated acreage of all existing wetlands on the property:
Pipe extensions
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:
Extend Existing Pipes by 10' on Each End.
3e. Describe the overall project in detail, including the type of equipment. to be used:
Extend the Existing Pipes by 10' on Each End.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property I
®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?
40. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Jay B. Johnson Other. NCDOT
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
April,2010
6. 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.
See DWQ Project 090389
6. Future Project Plans
6a. 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
Ia. Which sections were completed below for your project (check all that apply):
? Wetlands X Streams - tributaries XBuffers
? 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 (Corpse 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary
W1 ? P ? T ? Yes ? Corps
0
0
? No ? DWQ .
W2 ? P ? T ? Yes ? Corps
? No ? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Carps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts 0.0
2h. 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. 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 X P ? T
Pipe Placement U/T of Indian
Well
X PER
X Corps
20'
10'
Swamp ? INT XDWQ
S2 ? PEI T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 [I P El T El PER ? Corps
El INT E] DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts 10'
3i. Comments:
Page 4 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 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?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts 0.0
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a.

Pond ID 5b.

Proposed use or purpose 5c.
Wetland Impacts (acres) 5d.
Stream Impacts (feet) 5e:
Upland
(acres)
number of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total 0.0 0.0 0.0
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes X No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
Page 5 of 11
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.
X Neuse ?Tar-Pamlico ? Other:
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 Pipe
Replac Tributary of Indian well ? Yes 600 Sq. Ft 400 Sq. Ft
amen
ement Swamp X No
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts 600 Sq. Ft 400 Sq. Ft
6i. Comments:
Page 6 of 11
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken.to avoid or minimize the proposed impacts in designing project.
I ti. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
All Construction Equipment Will Be Operated Within The Footprint of the Existing Roadway So As To Prevent
The Disturbance Of Any Vegetated Areas Or Jurisdictional Waters At The Site
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 XNo
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
? Pennittee Responsible Mitigation
3. Complete If Using a Mitigation Bank NIA
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, N/A
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 NIA
5a. If using a pennittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 7 of 11
PCN Form - Version 1.3 December 10, 2008 Version
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ N/A
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes X 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:
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:
Page 8 of 11
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 X 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: Diffuse Flow Through Vegetated Uplands Before Entering X Yes ? No
Wetlands Will Be Used For This Pipe Replacement
2. Stormwater Management Plan
2a . What is the overall percent imperviousness of this project? 0%
2b. Does this project require a Stormwater Management Plan? Yes X 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, narrative description of the plan:
? 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 Stormwater Review N/A
3a. In which local government's jurisdiction is this project?
? Phase II
3b. Which of the following locally-implemented stormwater management programs ? NSW
? USMP
apply (check all that apply): ? Water supply Watershed
? Other:
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
X Other. NPDES Permit
4b. Has the approved Stormwater Management Plan with proof of approval been
? Y
XN
attached? es
o
5. DWQ 401 Unit Stor mwater Review NIA
5a. Does the Stormwater Management Plan meet the appropriate requirements? XYes ? No
5b. Have all of the 401 Unit submittal requirements been met? X Yes ? No
Page 9 of 11
PCN Form - Version 1.3 December 10, 2008 Version .
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. ff 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 ? No
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 Welland Standards, ? Yes ® 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 narrafive 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.
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 N No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes N No
impacts?

Raleigh
?
Sc. If yes, indicate the USFWS Field Office you have contacted. h
ill
? A
s
ev
e
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NHP GIS Data Layer and Onsite Observation
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes N No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
North Carolina Wildlife Resources Commission
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 O 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?
North Carolina State Historic Preservation Office
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? N Yes ? No
lib. If yes, explain how project meets FEMA requirements: The Pipe Replacement Will Not Raise the Elevation Within The
Fooodplain
8c. What source(s) did you use to make the floodplain determination? NC Flood Map
Jay B. Johnson \ March 13, 2009
Applicant/Agent's Printed Name Ap 1 g s Signature
" Date
(Agent's signature is v
onl a ionzation letter from the epplicant
Is provided.)
Page 11 of 11
SR 1711, WORTHINGTONROAD
PITT COUNTY - T
WIDENING FROM SR 1700, OLD TAR ROAD TO NC 43
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