20050455 Ver 1_Complete File_20060922

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OATH CAROLINA ENO rgTFR 206
STATE OF N
DEPARTMENT OF TP ANSPORTATION
LYNDo TIPPER
MICHAEL R EASLEY SECRETARY
GC V FkNOR
U.S. Army Corps of Engineers
Wnshington Regulatory Field Office
P.O. Box 1000
Washington, NC 27889-1000
A`I ENTlON- Mr. Bill Biddlecome
NCDOT Coordinator
SUBJECT : Dewatering for Qre repair of three existing pipes under SR 1001 in Berrie County
Dear Sir'
NCDOT is requesting a NW 33 permit for dewatering activities associated with a pipe repair
project. The pipes were damaged by a utility contractor boring a 16 inch utility line through three pipes.
The damaged has caused roadway shoulder fill to collapse anti create a hole. This damaged pipe must be
repairLd prior to the road opening. IQ the traveling public. It is currently unsafe to travel and is closed.
Included with this request letter is a PCN form and a permit. drawing. If any additional infomiation is
needed. please contact Clay Willis at [phone].
Sincerely,
Anthony Roper, Division Engineer
Ditizsicn One
Clay Willis, Environmental Superyisaf
Division One
September 13, 2006
Sc)q 5 5
V, Z
cc, Garry Ward, DWQ
MAILING ADDRE6S:
NC DEPARTMENT O: TRAti-PORTATION
PROJECT QLYELGPMEN'f N+= FNNR3-ENTA6Aw.-.1-
1548 MAIL, SERVICE CHTER
RALEioHNC 27999-164S
TELEPHONE' 819•T33.3141
FAX: 919 X33 97Bti
WCESTE; yyWW.0WD0T.5TATE,NC-U3
LQC;ATtGN:
TRA1J,'',PORTATION BUILDING
1 SOUTH OLVINGTONSTREIT
FULU.. NC
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Office Use Only:
USACE Action ID No.
(Tf any partiv
i. 'processing

Form version kiny 2002
DWQ No.
item is not applicable to this project, please entar "Not Applicable" or "N/A".)
1. Check all of the approval(s) requested for this project:
F1 Section 404 Permit ? Riparian or Watershed Huffer Mules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NW33
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: Q
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
S. if your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Managcment Area of
Environmental Concern (see the top of page'_) for further details), check here: ?
CI. Applicant Information
1. Owner/Applicant Information
Name: North Carolina D attment of Transportation
Mailing Address: 113 Ai Mort Drive Suite 100
Edenton NC 27932
Telephone Number: [phone] _ Fax Number: [phone]
E-mail Address;
2. Agent/Consultant information (A signed and dated copy of the Agent Authorization. letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: Clay Willis
Company Affiliation: Environmental Officer
Mailing Address:
Telephone Number'
Fax Number:
E-mail Address: tcwillisrdat.state.ne.us
Page 5 of I?
?9;'Lq; iGib 09:42, UPJISIOtI 1 EEEPJTOhd 91E5?= ??+_15 hJO.^7 DO
[I. Project Information
Anach a vicinity map clearly showing the location of the property with respect to local
landmarks such as tovN>rs, rivers, and roads. Also provide a detailed site plan showing property
boundaries and devolopment plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildinD,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate iJSGS Topographic Quad Map and MRCS Sell Survey with tho property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For adminimative and distribution purposes, the
USACE rNuires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ preferat full-sizo construction
drawings rather than a sequential sheet version of the Lull-size plans. If fall-size plans are
reduced to a small scale; such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps ate provided.
1. Name of project: Pipe repair on SR 1001 Wakelon Road in Bertie Count
2. T.I.P. Project Number or State Project Number (NCPOT Only}:
3. Property Identification Number (Tax PIN):
3. Location
County: Bertie Nearest Town: Windsor
Subdivision name (include phasMot number):
Directions to site (include road numbers, landmarks, etc,): Take US 17 north from Windsor
towards Edenton. Go approximately 4 miles and take a left onto SP 1001 Wakelon Road .
Go approximately 4.6 miles until ou reach Fbit Swain .
5. Site coordinates, if available (UTM or LatJLong): 36.076966 N 76,870891 W
(Note - if project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
ft. Propetty size (acre>): 0.22 acrea
7. Nearest body of water (stream/riverJsourld/ocean/lake): Flat Swamp
8. River Basin: Roanoke _
(Note - this must be one of North Carolina's sevetlteen designated major river basins. The
River Basin map is availablo ar. hit salh2o,enrstote.nauslac7min?ma s/.)
9. Describe the existing conditions on the site and general land use uz the vicinity of the project
at tho time of taus application'_ Land use is nenerally residential agricultural and
commercial.
P-,tge 6 of 12
51° PJJ. D??
:?9/14,,DOD ??'3:-1= D11)"S10H 1 F-EDAT01.1 9L ?=
Describe the overall project in detail, including the type of equipment to be used:
of
The proposed work involves fixing three dammed piney by deWaterin? the damaged area
the i e and placing bands around hole in 2i Re. Some weldin of the i e holes will be
required. which will necessitate the need for a d work area. This will be done using
NCDOT Rest Management Practices for dewaterine All water bein um ed out will be
Pumped into a silt check smtcture to prevent increased turbidity. All ettidelines for soil and
erosion control will be followed in this rpCe-?s.
10. Explain the purpose of the proposed work, 4llowi contractor to repair the pipes as needed
IV. Prior Project History
if jurisdictional detezntinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the 05ACE Action 16 Number, DWQ Project Number, application date, and date pannit5 and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
Certifications or other useful information. Describe previously approved wetland, stream] and
buffer impacts, along with associated mitigation (where applicable). If this is a NGPOT project,
list and describe permits issued for prior aegnents of the same T.I.P. project, along with
constrvetion Schedules.
A permit was issued for these i e nlacements in 7005 COE permit 200510838 and 200510861
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide Justification for the exclusion of this work 6-om the current application.
None
Vl. Proposed impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must, also
provide justification for these impacts in section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list. and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts: All impact.; asfiaeiated with the
dewnterine of the nine replacement site will be temporary.
Page 7 of 12
PJO. Df?9
09.' 1 a "'DOG 09: 4_ L I (! i E I iJt J 1 EED ITON ? 91_252=__'e9215
2. Individually list wetland impacts beloty: Temporary fill from gavel dam
Wetland Impact Arco of Lot Ated within Di.=ce to
Site Number Type of Impact• Impaci 100-year Fioodplain"' Ncutst Stream Type of Wetland*'f*
inaicav:9P in:c) (acres (vesln0) (linear feet)
Temporary fill 0.012 _ Yes I rivenne
List wch impact sepa;atciy 1nJ identify tcmpdntry ip1p9ct5. Imprtets include, buT are not limited co: nlechrnizrd clearing, grading, F'11,
exo3vation, FlocOing, ditching/drainage, etc. For drma, separately list imp:.cts due to both structure and flooding
•? 100-Year Iloodplainy are identified through the Federal F-rnergency Mana?Vmcnt Agency's (FE"AA) Flood [nsurance. Race Meps
(FIRM), or FEMA-approved )"al Lodplain maps. MEps sire availsble throw': die FEMA A13p Service Cc:nt_r at 1-2,0(? 3 54616, nr
online d1 t n''%www.fcme,, .
?'• List a wetland ryre that best d_;cribcs wetland to be impaetc:d frcshwatLTrSoltwarer mursh, farestcd waland, beaver pond,
Carolina Bay, bog, etc,) indicate if waland i3 Mated (dcterntii :zaion of isoluticn to be made. by USAC'_ only).
List the total acreage (estimated) of all existing wetlands on the property: 1.00
Total area of wetland impact proposed: 0 are
3. Individually list all intermittent and cr=1Al scream imp acts below: None
Average Width Perennial 4r
Stream Impact I I Length of
Sitz Number Type of Impstt• Impact Stream Name" of Stream InterminertO
(indicate on maps (linear feet) Before Im t,e[ ! lease s ecif
List e: Ch inlPW SEPNately and identify lanporary irlpa:ts, impncU tneludt, tut ere not nrrtteu rU. ULIIVOu 11110 asw"LQL?u
Cants (s p:rotcly list impacts due to loth smtcture and flooding), relocation (include linear fear before and atler, and net loss/$ainj,
suibilizntion activities (cement w:)U, rip ra?, crib wall, glbions, ctc.), excavation, dit6insistr51611cming, etc. If strcert relocation is
proposed, plans oxd profiles showing, the linear foocarint fer both the original and TO(I nted streams rnu>t be included.
Stream names am be found on USGS tDjv_k'rLphic maps. If a stream hiss no ntun:, list us UT (unnamej triburary) to the neare9t
dawnstream namcd strum into ah,icit it tlowi USCS maps arc dvuilable dirough the USGS M I-ROO-358-9616, or online at
V%V".utij!?.<'0V. Scvcral intcrnet sites alio allow dirt download and pnntirg of USGS traps (e g•,
ww',v rnnpgljGi1 i'in?t, 7Gl
cumulative impacts (linear distance in feet) to all streams on site: 0 linear feet
Individually list all open water impacts (including lakes; ponds, estuaries, sounds, Atlantic
/lnunn 11nri onv [)Thar crater of the i'_S_) below: None
Open Water Impact w •• y~ Area of
Name of Watcrbody
' T)pe of waterbndy
es , sound,
ldkt
t " pond

Site Number
indicate on ma)
TyTe of Impact
Impact (if applicable)
t
,
,
bay, ocean. etc.)
I
Glt rlfnrl rtinn
List Bch impact scH.rntcly raid identify tempotury impace, ltnpuCU inciuge, out are not Innrteu tu. c.•wvauv,,, „"tr '.•
flooding, dratnGge, bulkheeds, etc.
j_ Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Page 8 of 12
09: l? DI1!iSIOtd 1 EL:EfJTGP! 912??=hg21_,
Doscribe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock. watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
VII.
Size of watershed draining to pond:
Impact Justification (Avoidance and Minimization)
Expected pond surface area:
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such a$ topography, building ordinances. accessibility, and
Rftanciai viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why These design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. if applicable, discuss construction
techniques to be followed during construction to reduce impacts.
VU1, Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than -or equal to one acre of impacts to
freshwater wetland: or greater than or equal to 150 linear feet of total impacts to pt=-nnial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Exmuples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters h-ach as streams; and replacing; losses of
aquatic resource functions and values by creating, restoring„ enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking s required Litigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review die cur=t guidelines for stream restoration
in DWQ's Draft Technical Gidde for Stream Work in North Carolina, available at
ihttp.lili2o enr state nc.us/ncwctlandslstnrmide.litml.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site locator. (attach directions
and/or map, if offsite), affected stream and river basin, type and tunount (acreage/linear feet)
Page 9 of :2
G19i14;t 006 09:4_ E1I1JISIOH 1 EEDITOP! G125?=SSGO1? 10. -Z
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictiors, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
All ternporary fill will be entire] removed thus no permanent im sets will result from
this re air work.
Mitigation may also be made oy payment into the North Carolina Wetlands Restoration
Program (NC't). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a. PCN. For additional information regarding the application process for the
NCIVR.P, check the NCVW website at httL/lhoo etu.state.nc.u5/wrp/uidex.htm. If use of
the NCWRP is proposed, pleas: check the appropriate box on page three and provide the
following in formation: N/A
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requestM (acres):_
1X.
X.
Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federaUstate) l end?
Yes Q No ?
If yes, does the project require preparation of an environmental document pursues to the
requirements of the National or :'forth Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to renew current tluesholds for environmental documentation.
Yes ? No ;c
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes Q No ?
Proposed Impacts on Riparian uad Watcrshcd Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and trap all impacts to
required state and local buffers associated with the project. The applicant must also provide
D11
Page 10 of 12
C-iq, - Iill-1 1011 1 ELEIITOH - 91?`27=??-1? hJi i. D1_
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 213 .0233
(Neese), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identi fy )?
Yes ? No 0 If you answered "yes", provide the following information,
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Impaot

Zonet
(s uae foal)

ultip[ier
ht Required

aticn
h4iti
l 3
1.5
Total
Zone 1 exirnds Cut 30 fret pfrK14icu1ar rrom near oank of cnurnei, cone
additional 20 feet from the rage of Zane I
1f buffer tttitigation is regUired, please discuss what type of mitigation is proposed (i.e.. Donation
of Propetly, Conservation Easement, Riparian Buffer Restoration I Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stortnwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwatcr controls proposed in order to prMCC surface waters and wetlands
downstream from the property.
Impervious acreage will remain the same.
aIL Sewage Disposal (required by DV /Q)
Clearly detail the ultimate tToptlnent methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project. or available capacity of the subject facility.
No wastewater will be generated at these crossings
Page 11 of 12
39i14.200h 09,4_ UIIIT SIotI I EEEHM-I 91??? h'?215

:CAI. Violations (required by DWQ)
is this site in violation of DWQ Wetland Rules (15A NCAC 214.0500) or any buffer Rules?
Yes ? No N
I& this an after-the-fact permit application?
Yes [] No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
wnstruction dates to allow processing time for these permits- However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species. accessibility problems, or other issues outside of the applicant's control).
q11 3/0
Appl"cant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of I2

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION '??<,'`
MICHAEL F. EASLEY
GOVERNOR
March 10, 2005
U. S. Army Corps of Engineers
Regulatory Field Office
Post Office Box 1000
Washington, N.C. 27889-1000
Attention: Bill Biddlecome

V
7;,GG }? ?:? s
LYNDO TIPPETT ??
SECRETARY ?G
Subject: Request for a NW 33 and a courtesy NW 3 for dewatering and pipe replacements on SR 1001
(Wakelon Road) in Bertie County.
This is a request from the North Carolina Department of Transportation for a NW 33 and a
courtesy NW 3 permit for the dewatering and pipe replacements on SR 1001 (Wakelon Road) in Bertie
County. Currently, there are four failing pipes 45' x 36" RCP and six failing pipes 45' X 48" CMP that
NCDOT would like to replace with five 50' x 87" x 63" CAPA. These pipes will have headwalls on the
upstream and downstream side along with 9' wing walls on all four corners. NCDOT would also like to
install one 50' x 48" CMP to be used as a diversion pipe just south of the proposed pipe replacements on
SR 1001. NCDOT would like to leave the pipe in place when all work is completed. The dewatering of
this area will allow for dry installation of the pipes. The widening of this road will ensure safer travel.
Permit drawings, a site location map, and both PCN forms are included in this letter. If you need any
additional information or have any questions concerning this project please call me at 252-482-7977.
Sincerely,
Anthony Roper, PE
Division One Engineer
U?
Clay Willis zj
Division One Environmental Officer
Cc:Nicole Thomson, DWQ
John Hennessy, DWQ
Rob Ridings, DWQ
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Office Use Only: 060,1 11
DWO No.
Form Version
USACE Action ID No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NW 3
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here:
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: Clay Willis, NC DOT Division One Environmental Officer
Mailing Address: 113 Airport Dr. Suite 100 Edenton, NC 27932
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: tcwillis(a),dot.state.ne.us
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: N/A
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
Page 3 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: SR 1001 (Wakelon Road) Bertie County
2. T.I.P. Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Bertie Nearest Town: Windsor
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): Take US 17 north from Windsor
towards Edenton. Go approximately 4 miles and take a left onto SR 1001 (Wakelon Road).
Go approximately 4.6 miles until you reach Flat Swamp.
5. Site coordinates, if available (UTM or Lat/Long): 36.076866N 76.870891W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
Woodland agriculture and commercial rural residential.
7. Property size (acres): 0.22 acres
8. Nearest body of water (stream/river/sound/ocean/lake): Flat Swamp
9. River Basin: Roanoke River
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://112o.enr.state.nc.us/admin/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work: To replace four failing pipes 45'x 36" RCP
and six failing pines 45' x 48"CMP with 5 new bigger pines 50'x 87" x 63" CAPA with
headwalls on the upstream and downstream side to allow the better flow of water. The
headwalls will have 9' wing walls on all four corners. Also, NCDOT would like to install a
new 50' x 48" CMP to be used as a diversion pipe just south of the proposed pipe
replacement location. NCDOT would like to leave this pipe in place and not remove it when
all work is completed.
11. List the type of equipment to be used to construct the project: excavator, backhoe, and dump
trucks
12. Describe the land use in the vicinity of this project: Woodland agricultural, and residential.
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
A request for a NW 33 permit to allow dewatering of the area around the pipes to allow for dry
installation is accompanying this application package.
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: None
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 5 of 12
1. Wetland Impacts
Wetland Impact
Site Number
indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
Site I Fill 0.008 Yes N/A Riverine Swamp
Site 2 Fill 0.001 Yes N/A Riverine Swamp

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, till,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains arc identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local tloodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at ham://www.Icma.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property:_
Total area of wetland impact proposed: 0.009 acres
2. Stream Impacts, including all intermittent and perennial streams:
Stream Impact
Site Number
indicate on ma)
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.uses.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., wWw.t0P07one.c0m,
www.mapyuest.com, etc.).
3. Cumulative impacts (linear distance in feet) to all streams on site:
4. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S. None
Open Water Impact *
Type of Impact Area of Name of Waterbody Type of Waterbody
Site Number Im act if applicable) lake, pond, estuary, sound,
Page 6 of 12
indicate on ma) (acres) bay, ocean, etc.
N/A
* List each impact senaratelv and identifv temaorarv impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation N/A
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
Size of watershed draining to pond: N/A Expected pond surface area: N/A
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
Imnacts were minimized by choosine the shortest pines possible while still allowin. adequate
water flow and wide shoulders for safe travel.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
Page 7 of 12
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http:/ih2o.enr.state.nc.us/ncwetlands/stnngide.litinl.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at t,ttn://h2o.enr.state.nc.tis/wm/index.htni. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
IX. Environmental Documentation (D`VQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Page 8 of 12
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ® If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 N/A 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 213.0242 or.0260.
N/A
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Impervious acreage will remain the same.
Page 9 of 12
XII. Sewage Disposal (DWQ Only)
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.
No wastewater will be generated
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
N/A
,0//C)/
Applicant/Agent's Signae Date
(Agent's signature is vA only if an authorization letter from the applicant is provided.)
Page 10 of 12
Office Use Only: Form Version May 2002
USACE Action ID No. DWQ No. (If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)

1. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NW33
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: North Carolina Department of Transportation
Mailing Address: 113 Airport Drive Suite 100
Edenton, NC 27932
Telephone Number: [phone] Fax Number: [phone]
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: Clav Willis
Company Affiliation: Environmental Officer
Mailing Address:
Telephone Number: Fax Number:
E-mail Address: tewillis(a,dot.state.ne.us
Page 5 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Pipe replacement on SR 1001 (Wakelon Road) in Bertie County
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):
4. Location
County: Bertie Nearest Town: Windsor
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): Take US 17 north from Windsor
towards Edenton. Go approximately 4 miles and take a left onto SR 1001 (Wakelon Road).
Go approximately 4.6 miles until you reach Flat Swamp.
5. Site coordinates, if available (UTM or Lat/Long): 36.076866 N, 76.870891 W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): 0.22 acres
7. Nearest body of water (stream/river/sound/ocean/lake): Flat Swamp
8. River Basin: Roanoke
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Land use is generally residential, agricultural, and
commercial.
Describe the overall project in detail, including the type of equipment to be used:
Page 6 of 12
The proposed work involves driving of 4X10 feet steel sheet to create a temporary dam that
will allow a pipe replacement to take place in the dry. The steel plate will be placed on the
downstream and upstream sides of the pipe This will be done using NCDOT Best
Management Practices for dewatering_All water being pumped out will be pumped into a silt
basin or silt bag to prevent increased turbidity. All guidelines for soil and erosion control
will be followed in this process
10. Explain the purpose of the proposed work: Allows contractor to replace the ape and build
headwall.
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
Yes. A courtesy NW 3 application package for pipe replacements at this location will be sent
along with this application package.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts: All impacts associated with the
dewatering of the pipe replacement site will be temporary.
Page 7 of 12
2. Individually list wetland impacts below: None
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(es/no) Distance to
Nearest Stream
linear feet)
Type of Wetland***

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditch in g/drai nage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at littp://wwNv.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: 1.00
Total area of wetland impact proposed: 0 acres
3. Individuallv list all intermittent and perennial stream impacts below: None
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and alter, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.us?,'s.stov. Several internet sites also allow direct download and printing of USGS maps (e.g., WWW.tOV07one.com,
www.mapquest. corn, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 0 linear feet
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and anv other water of the U.S.) below: None
Open Water Impact Area of Name of Waterbody Type of Waterbody
Site Number Type of Impact* Impact (if applicable) (lake, pond, estuary, sound,
(indicate on ma) (acres) bay, ocean, etc.

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Page 8 of 12
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
The existing pipes are being replaced to improve hydraulic flow of the swamp. Temporary
construction impacts will occur and cannot be avoided except by choosing a no-build
alternative Impacts will be minimized by performing all pipe replacement activities from the
existing roadway. Excavation will be confined to the right of way and limited to the minimum
amount required to replace the ape and restore the original channel dimensions. All excavated
materials will be removed from the site.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
Page 9 of 12
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
llttl2://h2o.enr.state.nc.us/ncwetlands/strnigidc.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at littp://h2o.enr.state.ne.us/wrp/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information: N/A
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
Page 10 of 12
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ® If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 3
2 1.5
Total
* Zone 1 extends out 3U tect pcrpcnMcwar from near nanK 01 cnannei; cone i extcnus an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 213.0242 or.0260.
Page 11 of 12
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Impervious acreage will remain the same.
XII. Sewage Disposal (required by DWQ)
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.
No wastewater will be generated at these crossings
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
0f'
ApplicantAgent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
March 14, 2005
Division of Water Quality
401/Wetlands Unit
1650 Mail Service Center
Raleigh, N.C. 27699-1650
Attention: Nicole Thomson
?l
qy ?p
os o
LYNDO TIPPI
SECRETARY
Subject: Request for a NW 3 for dewatering and pipe replacements on SR 1001 (Wakelon Road) in Bertie
County.
This is a request from the North Carolina Department of Transportation for a NW 3 permit for the
pipe replacements on SR 1001 (Wakelon Road) in Bertie County. Currently, there are four failing pipes
45'x 36" RCP and six failing pipes 45'X 48" CMP that NCDOT would like to replace with five 50'x 87"
x 63" CAPA. These pipes will have headwalls on the upstream and downstream side along with 9' wing
walls on all four corners. NCDOT would also like to install one 50' x 48" CMP to be used as a diversion
pipe just south of the proposed pipe replacements on SR 1001. NCDOT would like to leave the pipe in
place when all work is completed. The dewatering of this area will allow for dry installation of the pipes.
The widening of this road will ensure safer travel. I have recently sent this permit application to you but
have learned that this area is an anadromous and resident fish spawning area with an in-water work
moratorium from February 15`h - June 30`h. Therefore, NCDOT is requesting 0.009 acres of riverine
swamp to be mitigated by the North Carolina Ecosysten Enhancement Program. Please include this correct
PCN form in the previous application package included in this letter. If you need any additional
information or have any questions concerning this project please call me at 252-482-7977. Thank You.
Sincerely,
Anthony Roper, PE
Division One Engineer
Clay Willis
Division One Environmental Officer
Cc Bill Biddlecome, USACOE
Rob Ridings, DWQ
John Hennessy, DWQ
Travis Wilson, WRC
Office Use Only: Form Version April 2001
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NW 3
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: Clay Willis, NC DOT Division One Environmental Officer
Mailing Address: 113 Airport Dr. Suite 100 Edenton, NC 27932
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: tcwillis(a-dot.state.ne.us
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: N/A
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 3 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: SR 1001 (Wakelon Road), Bertie County
2. T.I.P. Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):
4. Location
County: Bertie Nearest Town: Windsor
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): Take US 17 north from Windsor
towards Edenton. Go approximately 4 miles and take a left onto SR 1001 (Wakelon Road).
Go approximately 4.6 miles until you reach Flat Swamp.
5. Site coordinates, if available (UTM or Lat/Long): 36.076866N 76.870891W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
Woodland, aericulture and commercial, rural residential.
7. Property size (acres): 0.22 acres
8. Nearest body of water (stream/river/sound/ocean/lake): Flat Swamp
9. River Basin: Roanoke River
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work: To replace four failing pipes 45'x 36" RCP
and six failing pipes 45' x 48"CMP with 5 new bigger pipes 50'x 87" x 63" CAPA with
headwalls on the upstream and downstream side to allow the better flow of water. The
headwalls will have 9' wing walls on all four corners. Also, NCDOT would like to install a
new 50' x 48" CMP to be used as a diversion Ripe just south of the proposed Pipe
replacement location. NCDOT would like to leave this pipe in place and not remove it when
all work is completed.
IV.
V.
VI.
11. List the type of equipment to be used to construct the project: excavator, backhoe, and dump
12. Describe the land use in the vicinity of this project: Woodland, agricultural, and residential.
Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
A request for a NW 33 permit to allow dewatering of the area around the pipes to allow for dry
installation is accompanying this application package.
Future Project Plans
Are any additional
anticipated work,
application: None
Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
permit requests anticipated for this project in the future? If so, describe the
and provide justification for the exclusion of this work from the current
Page 5 of 12
1. Wetland Impacts
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(yes/no) Distance to
Nearest Stream
linear feet)
Type of Wetland***
Site 1 Fill 0.008 Yes N/A Riverine Swamp
Site 2 Fill 0.001 Yes N/A Riverine Swamp

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://www.fema. ,ov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: 0.5 acres
Total area of wetland impact proposed: 0.009 acres
2. Stream Impacts, including all intermittent and perennial streams: N/A
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please secif
Stream A

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditch ing/stmightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.uses.gov. Several intemct sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapquest.com, etc.).
3. Cumulative impacts (linear distance in feet) to all streams on site:
4. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S. None
Page 6 of 12
indicate on ma (acres) bay, ocean, etc.
N/A
List eacn impact separately ana tacnttty temporary impacts. impacts tncwae, but are not umttea to: nu, excavation, arcagmg,
flooding, drainage, bulkheads, etc.
5. Pond Creation N/A
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
Size of watershed draining to pond: N/A Expected pond surface area: N/A
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
Impacts were minimized by choosing the shortest pipes possible while still allowing adequate
water flow and wide shoulders for safe travel.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
Page 7 of 12
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://l12o.enr.state.nc.us/ncwetlands/strmgide.htni1.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
NCDOT is requesting 0.009 acres from the North Carolina Ecosystem Enhancement Program
to compensate for the unavoidable impacts.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wrp/index.htni. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ® No ?
Page 8 of 12
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ® If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 N/A 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 213.0242 or.0260.
N/A
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Impervious acreage will remain the same.
Page 9 of 12
XII. Sewage Disposal (DWQ Only)
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.
No wastewater will be generated
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
Applicant/Agent's Sig;
(Agent's signature is v
L)Z? e [I o/ O?E;-
Date
only if an authorization letter from the applicant is provided.)
Page 10 of 12