20110524 Ver 1_Application_20110531

B-5201 Page 1 of 1
B-5201
Ward, Garcy
Sent: Friday, July 15, 2011 9:45 AM
To: Johnson, Jay B; Sutton, Michael W
Cc: Steffens, Thomas A SAW [[e-mail]]; Lane, Stephen; Carrillo, Sonia; Ward, Garcy
Jay,
I've reviewed your application requesting a 404/401/Buffer Authorization for the replacement of Bridge # 33
over a UT to the Intercepting Canal (Cuckolds Creek) on NC 99 in Beaufort County (DWCt project ft 11-0524). It
was determined that this feature is a man-made canal and is not subject to the Tar-Pamlico Buffer Rules (15A
NCAC 26 .0259). Therefore, a Buffer Authorization is not necessary. You may proceed under the conditions of
Water Quality Certification # 3687 which corresponds to the Nationwide Permit 3 issued by the Corps of
Engineers. Written approval is not necessary for use of this Certification provided the conditions of the
Certification can be met. If any of the conditions cannot be met, written approval may be required. Please let
me know if you have any questions.
Garcy
E-mail correspondence to and form this address may be subject to the North Carolina Public Records Law and
may be disclosed to third parties.
https://legacy.nc.gov/owa/?ae=Item&t=IPM.Note&id=RgAAAADMSzLcd9 W 2TJHI4%2b... 7/15/2011

~;:~~N
IIPPLICATiON for ~ a~~h
a'-a~-n
Major Development Permit ~ 1 ®5 2 ~
(last revised 12!27/06)
North Carolina DIVISION OF COASTAL MANAGEMENT
1. Primary ApplicanU Landowner Information
' Project Name ('rf applicable)
Business Name B-5201 Beaufort 33 NC 99 Over U/T Cuckolds Creek
North Carolina Department Of Transportation Pantego Township Beaufort County WBS Element
Number 45299
Applicant 1: First Name MI Last Name
Jay _ B. Johnson
Applicant 2: First Name MI • Last Name
I1 additional applicants, please attach an additional page(s) with names li sted.
Mailing Address PO Box ~ City State
1587. Greenville NC
ZIP Country Phone No. FAX No.
278351587 US 252-830-3490 eM.248 252-830-3341
Street Address (d different fmm above) City State ZIP
Email
[e-mail]
2. Agent/Contracfor Information
Business Name
AgenU Contractor 1: First Name MI Last Name
AgenU Contractor 2: First Name MI Last Name
Mailing Address PO Box City State
ZIP ~ Phone No. 1
-
- ext. Phane No. 2
- - ext.
FAX No. Contractor #
Street Address (d di/fen=nt /mm above) City State ZIP
Email
<Forrn continues on back>

Fonn DCM MP-1 (Page 2 of 5)
APPLICATION far
Major Development Permit
3. Project Location
County (can be mukiple) Street Address State Rd. #
Beaufort NC 99
Subdivision Name City State Zip
Phone No. Lot No.(s) (i/many, attach additional page with list)
_ _ ext.
a. In which NC over basin is the project located? b. Name of body of water nearest to proposed project
Tar-Pamlico Ulf Cuckolds Creek
c. Is the water body ident'fiied in (b) above, natural or manmade? d. Name the dosest major water body to the proposed project ske.
^Natural ®Manmade ^Unknown Cuckolds Creek
e. Is proposed work wkhin city limits or planning judsdiction7 f. If applicable, list the planning jurisdiction or dty limk the pro
osed
^Yes ®NO p
work falls wkhin.
None
4. Site Description
a. Total length of shoreline on the trail (R.) b. Size of entire trail (sq.ft.)
560' (260' East and 300' West) N/A
c. Size of individual Id(s) d. Approximate elevation of trod above NHW (normal high water) or
NWL (normal waterlevel)
(If many lof sizes, please attach additional page wdh a list) 9.9' ^NHW or ®NWL
e. Vegetation on trail
Maintained Roadside Grasses
f. Man-made features and uses now on trail
Bridge
g. Identify and describe the existing land uses adjacent to the proposed project ske.
Agricultural Property
h. How does locatgovemment zone the trail? - i. Is the proposed project consistent with the applicable zoning?
N/A (Attach zoning compliance certificate, k applicable)
^Yes ^NO ®NA
j. Is the proposed activity part of an urban waterfront redevebpment proposals Yes No
k. Has a professional arohaeolo9ical assessment been done for the tract? If yes, attach a copy. Yes No NA
If yes, by whom?
I. Is the proposed project located in a National Registered Historic District or does k involve a Yes No NA
National Register listed or eligible property.
<Form continues on next page>
m. (i) Are there wetlands on
(ii) Are there coastal wetlands on the ske?
^Yes ®No
(iii) k yes to ekher (i) or (ii) above, has a delineation been conducted? ®Yes ^No
(Attach documentation, if available)

Form DCM MP-1 (Page 3 of 5)
APPLICATION for
Major Development PennR
n. Describe existing wastewater treatrnent fadltties.
N/A
o. Describe existing ddnking wafer supply source.
N/A
p. Describe existing storm water management or treatment systems.
N/A
5. Activities and Impacts
a. Will the project be for commercial, public, or private use? Commercial ®PubliclGovemment
^Pnvate/Community
b. Give a brief description of purpose, use, and daily operations of the project when complete.
The Existing 36' Long by 28.3' Wide Timber Bridge Will Be Replaced By a Proposed 55' Cored Slab Bridge.
c. Describe the proposed construction methodology, types of censWdion equipment to be used dudng construction, the number of each type
of equipment and where tt is to be stored. "
The Existing Bridge WII Be Removed and the Proposed Bridge Will Be Constructed. Typical Bridge Construction
Equipment Will Be Used, Including,But Not Limited To Tracked Excavators,Dump Trucks, Flat-Bed Trucks,Back-Hoes,And
Boom Trucks
d. List all development activities you propose.
Bridge Replacement, Pipe Replacement, and Resurfadng.
e. Are the proposed activities maintenance of an existing project, new work, or both? Both
f. What is the approximate total disturbed land area resulting from the proposed project? 17,000 ®Sq.Ft or ^ACres
g. Will the proposed project encroach on any public easement, public accessway or other area Yes ^NO ®NA
that the public has established use oY.~
h. Describe location and type of existing and proposed discharges to waters of the state.
N/A
i. Will wastewater or storrnwater be discharged into a wetland? Yes No NA
It yes, will this discharged water be of the same salinity as the receiving wateR ^Yes ^No ^NA
j. Is there any mttigation proposed? Yes ®NO NA
If yes, attach a mitigation proposal.
<Fotm continues on back>
6. Additional Information
In addition to this completed application form, (MP-1) the following items below, it applicable, must be submitted in onier for the application
package to be complete. Items (a) - (f) a2 aAvays applicable to any major development application. Please consuR the application
instruction booklet on how to pmpedy prepare the required items bebw.
a. A project nartative.
b. An accurate, dated work plat (including plan view and cross-sectional drawings) drawn to scale. Please give the present status ct the
proposed project. Is any portion already complete? If previously authorized work, clearty indicate on maps, plats, drawings to distinguish
between work completed and proposed.
c. A site or location map that is suffidentty detailed to guide agency personnel unfamiliar with the area to the site.

Form DCM MP-1 (Page 4 of 5)
APPLICATION for
Major Development Permit
d. A copy of the deed (with state application only) or other instrument under which the applicant claims title to the affected properties.
e. The appropriate application fee. Check or money order made payable to DENR.
f. A list of the names and complete addresses of the adjacent waterfront (dpartan) landowners and signed return receipts as proof that such
owners have received a copy of the application and plats by certified mail. Such landowners must be advised that they have 30 days in
which to submit cemmerds on the proposed projed to the Division of Coastal Management.
Name R. H. Bishop,Jr.
Phone No.
Address 643 Water Street Belhaven, NC 27810 Parce14656
Name
Phone No.
Address
Name
Phone No.
Address
g. A list of previous state or federal permits issued for work on the projed trail. Include permit numbers, permittee, and issuing dates.
None
h. Signed consultant or agent authorization form, if applicable.
i. Wetland delineation, 'rf necessary.
j. A signed AEC hazard notice for projear in oceanfront and inlet areas. (Must ba signed by property owner)
k. A statement of compliance with the N.C. Environmental Policy Ad (N.C.G.S. 113A 1-10), 'rf necessary. If the projed involves expenditure
of public funds or use of public lands, attach a statement documenting compliance with the North Carolina Environmental Policy Ad.
17. Certification and Permission to Enfer on Land I
I understand that any permit issued in response to this application will allow only the development described in the appliption.
The project will be subject to the conditions and restrictions contained in the permit.
I certify that I am authorized to grant, and do in fact grant permission to representatives of state and federal review agendes to
enter on the aforementioned lands in connection with evaluating information related to this permit application and follow-up
monitoring of the projed.
I further certify that the information provided in this application is truthful to the best of my knowledge.
Date May 6, 2011 Print Name _Jay B. Joh so~
Signature
Please indicate application attachments peRaining to your proposed projed.
®DCM MP-2 Excavation and Fill Information ®DCM MP-5 Bridges and Culverts
^DCM MP-3 Upland Development -
^DCM MP-4 Structures Information

Form DCM MP-2

(Except for bridges and culverts)
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of the Joint
Application that relate to this proposed project. Please include all supplemental information.
Describe below the purpose of proposed excavation and/or fill activities. All values should be given in feet
Access Other
Channel
NLW Canal Boat Basin Boat Ramp Rock Groin Rock (excluding
(
or Breakwater shoreline
NWL stabilization

Length
Width
Avg. Existing
Depth NA NA
Final Project
Depth NA NA
L1. EXCAVATION ®This section not applicable
a. Amount of material to be excavated from below NHW or NWL in b. Type of material to be excavated.
cubic yards.
c. (i) Does the area to be excavated include coastal wetlands/marsh d. High-ground excavation in cubic yards.
(CW), submerged aquatic vegetation (SAV), shell bottom (SB),
or other wetlands (WL)? It any boxes are checked, provide the
number of square feet affected.
^CW ^SAV ^SB
^WL ^NOne
(ii) Describe the purpose of the excavation in these areas:
2. DISPOSAL OF EXCAVATED MATERIAL ®This section not applicable i
a. Location of disposal area. b. Dimensions of disposal area.
c. (i) Do you Gaim thle to disposal area? d. (i) Will a disposal area be available for future maintenance?
^Yes ^No ^NA ^Yes ^No ^NA
(ii) If no, attach a letter granting permission from the owner. (ii) If yes, where?
e. (i) Does the disposal area include any coastal wetlandslmarsh f. (i) Dces the disposal include any area in the wateft
(CW), submerged aquatic vegetation (SAV), shell bottom (SB), ^Yes ^No ^NA
or other wetlands (WL)? If any boxes are checked, provide the -
number of square feet affected. (ii) If yes, how much water area is affected?
^CW ^SAV ^SB _
^WL ^NOne
(ii) Describe the purpose of disposal in these areas:
3. SHORELINE STABIL/ZAT/ON ^This section not applicable
(If development is a wood groin, use MP-4 -Structures)

Form DCM MP-2 (Excavation and Fill, Page 2 of 2)
a. Type of shoreline stabrlo:ahon: b. Length: 160' f80' East And 80' Westl
^Bulkhead ®Riprap ^Breakwater/Sill ^Other: _ Width: 6'-10'
c. Average distance watenvard of NHW or NWL: 0 d. Maximum distance waterward of NHW or NWL: 0
e. Type of stabilization material:
Granite
g. Number of square feet of fill to be placed below water level.
Bulkhead backfill _ Riprap 0
Breakwater/Sill Other
f. (i) Has there been shoreline erosion during preceding 12
months?
^Yes ®No ^NA
(ii) If yes, state amount of erosion and source of erosion amount
information.
h. Type of
Granite
i. Source of fill material.
4. OTHER FILL ACTIVITIES
(Excluding Shoreline Stabilization) ~ ®This section not applicable
a. (i) Will fill material be brought to the sde? Yes ^No ^NA~ b. (i) Will fill material be placed in coastal wetlands/marsh (CW),
If yes,
(ii) Amount of matedal to be placed in the water
(iii) Dimensions of fill area
(iv) Purpose of fill
submerged aquatic vegetation (SAV), shell bottom (SB), or
other wetlands (WL)? If any boxes are checked, provide the
number of square feet affected.
^CW ^SAV ^SB
^WL ^NOne
(ii) Describe the purpose of the fill in these areas:
a. How will excavated or fill matedal be kept on site and erosion b. What type of construction equipment will be used
controlled? backhoe, or hydraulic dredge)?
Silt Fences and Rip Rap Typical Road and Bridge Construction Equipment
c. (i) Will navigational aids be required as a result of the project? d. (i) Will wetlands be crossed in transporting equipment to project
^Yes ®NO ^NA site? ^Yes ®No ^NA
(ii) If yes, explain what type and how they will be implemented. (ii) If yes, explain steps that will be taken to avoid or minimize
environmental impacts.
May 6, 2011
P
pliwnt S~ natt
Date
B-5201 Beaufort 33 NC 99 Over U/T Cuckolds Creek Pantego
Township Beaufort County WBS Element Number 45299
Project Name
Jay B. Johnson
plicant Name

Form DCM MPtiS
and CULVERTS
Attach this form to Joint Application for CAMA Major Permit, Fonn DCM MP-1. Be sure to complete all other sections of the Joint
Application that relate to this proposed project. Please indude all supplemental information.
!. BRIDGES ^This section not applicable
a. Is the proposed bridge:
^Commercial ®PublidGovemment ^Private/Community
c. Type of bridge (construction material):
Proposed 21" Cored Slab Bridge
b. Water body to be crossed by bridge:
U/1" Cuckolds Creek
d. Water depth at the proposed crossing at NLW or N1NL:
2'
e. (i) Will proposed bridge replace an existing bridge? ®Yes ^No
If yes,
(ii) Length of existing bridge: 36'
(iii) Width of existing bridge: 28.3'
(iv) Navigation clearance undemeath existing bridge: 9'
(v)WII all, or a part of, the existing bridge be removed?
(Explain) All of the Existing Bridge will be Removed
9~ Length of proposed bridge: 55'
i. Will the proposed bridge affect existing water flow? ^Yes ®No
If yes, explain:
k. Navigation clearance underneath proposed bridge: 9'
f. (i) Will proposed bridge replace an existing culvert? ^Yes ®No
If yes,
(ii) Length of existing culvert:
(iii) Width of existing culvert:
(iv) Height of the top of the existing culvert above the NHW or
NWL:
(v) Will all, or a part of, the existing culvert be removed?
(Explain)
h. Width of proposed bridge: 33'
j. Will the proposed bridge affect navigation by reducing or
increasing the existing navigable opening? ^Yes ®No
If yes, explain:
1. Have you contacted the U.S. Coast Guard wnceming their
approval? ^Yes ®No
If yes, explain:
m. Will the proposed bridge cross wetlands containing no navigable n. Height of proposed bridge above wetlands: ~ N/A
waters? ^Yes ®NO
If yes, explain:
2. CULVERTS
a. Number of culverts proposed:
®This section not applicable
b. Water body in which the culvert is to be placed:
< Form continues on back>

'~D!'t?~ ~rCi1A :111 ~-~ (Bridges and Culverts, Page 2 of 4)
c. Type of culvert (construction material):
d. (i) Will proposed culvert replace an existing bridge?
^Yes ^No
If yes,
(ii) Length of existing bridge:
(iii) Width of existing bridge:
(iv) Navigation clearance underneath existing bridge:
(v) Will all, or a part of, the existing bridge be removed?
(Explain)
f~ Length of proposed culvert:
h. Height of the top of the proposed culvert above the NMN or NWL.
0'
j. Will the proposed culvert affect navigation by reducing or
increasing the existing navigable opening? ^Yes ^No
If yes, explain:
e. (i) Will proposed culvert replace an existing culvert?
^Yes ^No
If yes,
(ii) Length of existing culvert(s):
(iii) Widlh of existing culvert(s): '
(iv) Height of the top of the existing culvert above the NHW or
NWL:
(v) Will all, or a part of, the existing culvert be removed?
(Explain)
9~ Width of proposed culvert:
i. Depth of culvert to be buried below existing bottom wntour.
1
k. Will the proposed culvert affect existing water Flow?
^Yes ^No
If yes, explain:
3. EXCAVATION and FILL ^This section not applicable
a. (i) Will the placement of the proposed bridge or culvert require any
excavation below the NHW or NWL? ^Yes ®No
If yes,
(ii) Avg, length of area to be excavated:
(iii) Avg. width of area to be excavated:
(iv) Avg. depth of area to be excavated:
(v) Amount of matedal to be excavated in cubic yards:
c. (i) Will the placement of the proposed bridge or culvert require any
high-ground excavation? ®Yes ^No
If yes,
(ii) Avg. length of area to be excavated: 21' East and 21'
West
(iii) Avg. width of area to be excavated: 26' East and 26' West
(iv) Avg. depth of area to be excavated: 2'
(v) Amount of material to be excavated in cubic yards: 60
Cubic Yards
b. (i) Will the placement of the proposed bridge or culvert require any
excavation within coastal wetlandslmarsh (CW), submerged
aquatic vegetation (SAV), shell bottom ($B), or other wetlands
(WL)? If any boxes are checked, provide the number of square
feet affected.
^CW ^SAV ^SB
^WL ®None
(ii).Descdbe the purpose of the excavation in these areas:

i°OY7Ti U~i>)I !!7 i°-$ (Bridyes and Culverts, Paye 3 of 4)
d. If the placement of the bridge or calved involves any excavation, please complete the following:
(i) Location of the spoil disposal area: Temporary Spoil Area is in the Existing Road
(ii) Dimensions of the spoil disposal area: 100' x 200'
(iii) Do you claim title to the disposal areal ®Yes ^No (I/no, attach a letter granting permission /rom the owner.)
(iv) Will the disposal area be available for future maintenance? ®Yes ^No
(v) Does the disposal area include any coastalwetlands/marsh (CW), submerged aquatic vegetation (SAVs), other wetlands (WL), or shell
bottom (SB)?
^CW ^SAV ^WL ^SB ®NOne
If any boxes are checked, give dimensions'rf different from (ii) above.
(vi) Does the disposalarea include any area below the NHW or NWL? ? ^Yes ®No
If yes, give dimensions "rf dfferent from (ii) above.
e. (i) Will the placement of the proposed bridge or culvert result in any
fill (other than excavated matedal described in Item d above) to
be placed below NHW or NWL? ^Yes ®No
If yes,
(ii) Avg. length of area to be filled:
(iii) Avg. width of area to 6e f Iled:
(iv) Purpose of fill:
f. (i) Will the placement of the proposed bridge or culvert result in any
fill (other than excavated material described in Item d above) to
be placed within coastal wetlands marsh (CW), submerged
aquatic vegetation (SAV), shell bottom (SB), or other wetlands
(WL)? If any boxes are checked, provide the number of square
feet affected.
^CW ^SAV ^SB
^WL ®NOne
(ii) Describe the purpose of the excavation in these areas:
g. (i) Will the placement of the proposed bridge or culvert result in any
fill (other than excavated material described in Item d above) to
be placed on high-ground? ^Yes ®No
If yes,
(ii) Avg. length of area to be filled:
(iii) Avg. width of area to be filled:
(iv) Purpose of fill:
a. Will the proposed project require the relocation of any existing b. Will the proposed project require the construction of any temporary
utility lines? ®Yes ^NO detour structures? ^Yes ®No
If yes, explain: Telephone Cable will be Relocated By If yes, explain:
Directional Bore.
if this portion of the proposed project has already received
appmval from local authorities, please attach a copy o/the
approval or certification.
< Form continues on back>

rDrYt7 7CN7 Pi13~-5 (Bridges and Culver#s, Page 4 of4) '
c. Will the proposed project require any work channelsT d. How will excavated or fill material be kept on'site and erosion
^Yes ®No controlled?
If yes, complete Form OCM-MP-2. Turbidity Curtains and Silt Fences will be used to retain
sediment on-site
e. What type of censtruction equipment will be used (for example,
dragline, backhoe, or hydraulic dredge)?
Typical Bridge Construction Equipment
f. Will wetlands be crossed in transporting equipment to project site?
^Yes ®No
If yes, explain steps that will be taken to avoid or minimize
environmental impacts.
g. Will the placement of the proposed bridge or culvert require any
shoreline stabilization? ®Yes ^No
I/yes, complete form MP-2, Section 3 /or Sho2lina
Stabilization only.
May 6,2011
Date
B-5201 Beaufort 33 NC 99 Over U/T Cuckolds Creek Pantego
Township Beaufort County WBS Element Number 45299
Project Name
Jay B. Johnson
Applicant a e
Applicant n u

.~>"~
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
Apri126, 201 I
WBS Element Number:
County:
Description:
MEMORANDUM TO:
FROM:
SUBJECT:
Division 2 respectfully request a CAM.A Section .1600 GP for the Telephone Line
Relocation as shown on the Utility Plans. Your assistance in this matter is greatly
appreciated.
45299
Beaufort
B-5201 Beaufort 33, NC 99 Over U/T Cuckolds Creek
Stephen Lane, NCDCM Field Representative
Jay Johnson
Division 2 Environmental Officer
Section .1600 GP Request
EocexE A. CONTI, JR.
SECRETARY
JBJ/ms
MAILING ADDRESS:
NC DEPARTMENT OF 7YtAN5PORTATION
DIVISION GF HIGHWAYS
P.O. Box 1587
GREENVEIE, NC 27835
71:I.EPHONE: [phone]
FAX: [phone]
LocnnoN:
P.O. Box 1587
GREENVR.LE,NC
WEBSRE: WWW.NCDOT.GOV

. 020 W ATF90G
I r >
~~®~~ o ~
Office Use Only:
Corps action ID no. ~~
DWO project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PC Form
A. A licant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps:
®Sedion 404 Perrnit ^ Section 10 Permit
1 b. Specity Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1c. Has the NWP or GP number been vedfied by the Corps? ^Yes ®No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification -Regular ^ Non-404 Jurisdictional General Permit
^ 401 Water Quality Certification -Express ®Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
^ Yes ®No For the record only for Corps Permit:

®Yes ^ No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ^Yes ®No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ®Yes ^ No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ®Yes ^ No
2. Project Information
2a. Name of project: B-5201 Beaufort 33 Bridge To Bridge Replacement NC 99 Over Uff Cuckolds Creek
WBS Element Number 45299
2b. County: Beaufort
2c. Nearest municipality /town: Pantego
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
project no: 45299
3. Owner Information
3a. Name(s) on Rewrded Deed: North Carolina Department of Transportation
3b. Deed Book and Page No. N/A
3c. Responsible Party (for LLC if
applicable): N/A
3d. Street address: 105 Pactolus Highway NC 33 P.O. Box 1587
3e. City, state, zip: Greeriville, NC 27835
3f. Telephone no.: 252-830-3490
3g. Fax no.: 252-830-3341
3h. Email address: [e-mail]
Page 1 of 11
PCN Form -Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is: ^ Agent ®Other, specify: Division 2 Environmental Officer
4b. Name: Jay B. Johnson
4c. Business name
(if applicable): North Carolina Depratment of Transportation
4d. Street address: P.O. Box 1587
4e. City, state, zip: Greenville, NC 27835
4f. Telephone no.: 252-830-3490
4g. Fax no.: 252-830-3341
4h. Email address: [e-mail]
5. Agenf/Consultant Information (if applicable)
5a. Name: N/A
Sb. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
Sf. Fax no.:
5g. Email address:
Page 2 of 11
PCN Form -Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a . Property identification no. (tax PIN or parcel ID): B-5201 Beaufort 33 NC 99 Over U/T Cuckolds Creek
Latitude: N 35.622147 Longitude: - W
1 b . Site coordinates (in decimal degrees): 76.637349
(DD.DDDDDD) (-DD.DDDDDD)
1c . Property size: N/A acres
2. Surtace Waters
2a . Name of nearest body of water (stream, river, etc.) to

proposed project: Cuckolds Creek, a Tributa of Pamlico River
rY
2b. Water Quality Classification of nearest receiving water: SC;NSW
2c. River basin: Tar-Pamlico Pamlico 03020104
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vidnity of the project at the time of this
application:
NC 99 is a paved Primary State Highway. Woodlands and Agriculture dominate the landscape.
3b. List the total estimated acreage of all existing wetlands on the property:
0 Square Feet of 404 Wetland Impacts For The Bridge To Bridge Replacement.
3c. List the total estimated linear feet of afl existing streams (intermittent and perennial) on the property:
60' This site is part of a longer adjacent stream system
3d. Explain the purpose of the proposed project:
Bridge To Bridge Replacement ;the existing bridge has deteoriated and needs replacing.
3e. Describe the overall project in detail, including the type of equipment to be used:
The Existing 36' Long RC Floor on Timber Pilings Bridge will be replaced with a Proposed 55' Long 21" Cored Slab
Bridge. Excavators,Dump Trucks,and Crane Trucks will be used for the Bridge To Bridge Replacement.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
t
i
l
i
®Yes ^ No ^ Unknown
projec
(
nc
ud
ng all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
^ Preliminary ^ Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?

Name (if known): Stephen Lane, NCDCM Jay Agency/Consultant Company:

Johnson,NCDOT Other: NCDCM and NCDOT
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
December 4, 2009
5. Project History
5a. Have permits or certifications been requested or obtained for ^Yes ®No ^ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
Page 3 of 11
PCN Form -Version 1.3 December 10, 2008 Version

6. Future Project Plans
6a. Is this a phased project? ^ Yes ®No
6b. If yes, explain.
'Page 4 of 11
PCN Form -Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
^ WeUands ®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) DWO -non-404, other) (acres)
Tem ora
W1 ^ P ^ T ^ Yes ^ Corps
^ No ^DWQ
W2 ^ P ^ T ^ Yes ^ Corps
^ No ^ DWO
W3 ^ P ^ T ^ Yes ^ Corps
^ No ^ DWO
W4 ^ P ^ T ^ Yes ^ Corps
^ No ^ DWO
W5 ^ P ^ T ^ Yes ^ Corps
^ No ^ DWO
W6 ^ P ^ T ^ Yes ^ Corps
^ No ^ DWO
2g. Total wetland impacts 0 Sq. Ft.
2h. Comments: 0 Sq. Ft. of 404 Wetland Impacts
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdid'ion Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or , intermittent DWO -non-404, width (linear
Temporary (T) (INS? other) (feet) feet)
S1 ®P ^ T Proposed Canal ®PER ^ Corps 35, 44 Linear.
Driveway Pipe ^INT ®DWQ Ft.
S2 ^ P ^ T ^PER ^ Corps
^ INT ^DWQ
S3 ^ P ^ T ^PER ^ Corps
^ INT ^ DWO
S4 ^ P ^ T ^PER ^ Corps
^ INT ^ DWO
S5 ^ P ^ T ^PER ^ Corps
^ INT ^ DWO
S6 ^ P ^ T ^PER ^ Corps
^ INT ^ DWO
3h. Total stream and tributary impacts 44 Linear
Ft.
3i. Comments: 44 Linear Feet of Stream Impacts
Page 5 of 11
PCN Form -Version 1.3 December 10, 2008 Version

4. Open Water Impacts -
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U. S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Watertxxiy type Area of impact (acres)
Permanent (P) or
Tem ora
01 ^P^T
02 ^P^T
03 ^P^T
04 ^P^T
4f. Total open water impacts None
4g. Comments: No Open Water Impacts
5. Porid or Lake Construction
If and or lake construction ro osed, then com lete the chart below.
5a. Sb. Sc. 5d. Se.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
Sf. Total None
5g. Comments: None
5h. Is a dam high hazard permit required?
^ Yes ^ No If yes, permit ID no:
5i. Expected pond surtace area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an im acts r uire miti anon, then ou MUST fill out Section D of this form.
6a.
^ Neuse ®Tar-Pamlico ^ Other: None
Project is in which protected basin? ^ Catawba ^ Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number- Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Tem ora im ad r wired?
B1 ®P ^ T Fill U/T Cuckolds Creek ®Nos 515 Sq. Ft. 385 Sq. Ft.
62 ®P ^ T Fill U/r Cuckolds Creek ®Nos 510 Sq. Ft. 340 Sq. Ft.
63 ®P ^ T Fill U/T Cuckolds Creek ®Nos 4740 Sq. Ft. 2825 Sq. Ft.
6b. Tatal buffer impacts
6i. Comments: See Page 6-A For Total Buffer Impacts
Page 6 of 11
PCN Form -Version 1.3 December 10, 2008 Version

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Tem ora
01 ^P^T
02 ^P^T
03 ^P^T
04 ^P^T
4f. Total open water impacts None
4g. Comments:
5. Pond or Lake Construction
If and or lake construction ro sect, then com lete the chart below.
Sa. 5b. 5c. 5d. Se.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID proposed use or purpose (acres)
number of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
Sf. Total None
Sg. Comments: None
Sh. Is a dam high hazard permit required?
^ Yes ^ No If yes, permit ID no:
5i. Expected pond surtace area (acres):
5j. Size of pond watershed (acres):
Sk. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an im acts re uire miti ation, then ou MUST fill out Section D of this form.
6a.
^ Neuse ®Tar-Pamlico ^ Other: None
Project is in which protected basin? ^ Catawba ^ Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number- Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Tem ra im act re wired?
B1 ®P ^ T B 4 Fill UIT Cuckolds Creek ®Nos 570 Sq. Ft. 340 Sq. Ft.
82 ^P^T ^Yes
^ No
63 ^P^T ^Yes
^ No
6h. Total butter impacts 6335Sq. Ft. 3890 Sq. Ft.
6i. Comments: 0.15 Acres of Buffer Zone 1 Impacts and 0.09 Acres of Buffer 2 Impacts
Page 3 of 10
PCN Form -Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
There are No 404 Wetland Impacts for this Project and No Coastal Wetland Impacts; However, There are 6335 Square Feet
of Buffer Zone 1 Impacts and 3890 Sq. Ft. of Buffer Zone 2 Impacts due to the installation of a Longer Bridge to Replace the
Existing Bridge. The Wetland Impacts have been minimized to the greatest extent feasible.
1b. Spec~cally describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Use of existing roadway to operate construction equipment; no equipment will enter wetlands.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State? ^ Yes ®No
2b. If yes, mitigation is required by (check all that,apply): ^DWQ ^ COrps

2c. If yes, which mitigation option will be used for this
project? - ^ Mitigation bank

^ Payment to in-lieu fee program -
^ Pennittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter ftom in-lieu fee program is attached. ^ Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ^ warm ^ cool ^cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 7 of 11
PCN Form -Version 1.3 December 10, 2008 Version

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) _'squired by DWQ '
6a. Will the project result in an impact within a protected riparian buffer that requires ^ Yes ®No
buffer mitigation?
6b. If yes, then identify the square feet of. impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required: None
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
pennittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
N/A
6h. Comments:
Page 8 of 11
PCN Form -Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a . Does the project include or is it adjacent to protected riparian buffers identified ®Yes ^ No
within one of the NC Riparian Buffer Protection Rules?
1b . If yes, then is a diffuse flow plan included? If no, explain why.
Comments: Storm Water will diffuse flaw through vegetated uplands before entering
wetlands. There are No Weep Holes on the Proposed Bridge, and stormwater is ®Yes ^ No
treated at the outlet pipe at Station 15+20 with Rack Inlet Sediment traps, Type C.
Stormwater will filter and diffuse flow through Special Sediment Control Fence.
2. Stormwater Mana ement Plan
2a . What is the overall percent imperviousness of this project? N/A Roadway/Bridge Project
2b . Does this project require a Stormwater Management Plan? ®Yes ^ No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
Stone Water will diffuse flow through vegetated uplands before entering wetlands. there are no Weep Holes on the
Proposed Bridge, and stortnwater is treated at the outlet pipe at Station 15+20 with R ock Inlet Sediment traps, Type C.
Stormwater will filter and diffuse flow through Special Sediment Control Fence.
^ Certified Local Govemment
2e. Who will be responsible for the review of the Stormwater Management Plan? ^ DWO Stormwater Program
® DWO 401 Unit
3. Certified Local Govemment Stormwater Review
3a. In which local government's jurisdiction is this project? N/A
^ Phase II
3b. Which of the following locally-implemented stormwater management programs ^ NSW
^ USMP
apply (check all that apply): ^ Water Supply Watershed
^ Other: N/A
3c. Has the approved Stormwater Management Plan with proof of approval been ^Yes ®No
attached?
4. DWQ Stormwater Pro ram Review
® Coastal counties
^ HOW
4a. Which of the following state-implemented Stormwater management programs apply ^ ORW
(check all that apply): ^ Session Law 2006-246
® Other: NPDES Permit
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ^Yes ®No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ^Yes ^ No
Page 9 of 11
PCN Form -Version 1.3 December 10, 2008 Version

Sb . Have all of the 401 Unit submittal requirements been met? ^ Yes ^ No
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a . Does the project involve an expenditure of public (federal/state/local) funds or the ®yes ^ No
use of public (federal/state) land?
1 b . 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)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ^ Yes ^ 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 Wetland Standards, ^ Yes ®No
or Riparian Buffer Rules (15A NCAC 28 .0200)?
2b. Is this an after-the-fact permit application? ^ Yes ®No
2c. If you answered "yes' to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ^ Yes ®No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discha rge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
N/A
Page 10 of 11
PCN Form -Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
Sa. Will this project occur in or near an area with federally protected species or ^ Yes ®No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ^ Yes ®No
impacts?
^ Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
^ Asheville
Sd. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
McTravis Wilson, NCWRC
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ^ Yes ®No '
6b. What data sources did you use to detenmine whether your site would impact Essential Fish Habitat?
Mc Travis Wilson, NCWRC
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state; federal or tribal
governments have designated as having historic or cultural preservation ^ Yes ®No
status (e.g., National Historic Trust designation or properties sign cant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NCDOT HEU Historic Architecture and Archaeology
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain? ®Yes ^ No
8b. If yes, explain how project meets FEMA requirements: Bridge designed to no-rise standards
8c. What source(s) did you use to make the floodplain determination? FEMA FIRM Maps
Jay B. Johnson May 6, 2011
ApplicanUAgenYs Printed Name ppli nU nt's Signature
' Date
n authorization letter from the applicant
(Agents signatu vat ty
mvided.
V
Page 11 of 11
PCN Form -Version 1.3 December 10, 2008 Version

Moratorium Beaufort 33.txt
From: Wilson, Travis W.
Sent: Thursday, November 19, 2009 12:52 PM
To: Sutton, Michael w
subject: RE: Division 2 Bridges
Mike, z think this covers all the bridge replacements protects you have requested
comments for, however if 2 have left off anything let me know.
B-5200: This crossing of Blount's Creek should have an anadromous fish moratorium
of Feb 15 to Tune 15.
8-5201: No concern
B-5202: No Concern
8-5203: No concern
8-5204: No Concern
B-5205: No Concern
8-4234: No concern
8-4236: No Concern
rf you have any more questions let me know.
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

Page 1 of
Frdm: Lane, Stephen
Sent: Friday, December 11, 2009 5:00 PM
To: Sutton, Michael W
Subject: Jurisdictional Determinations
Hi Mike,
I have visited the following sites at your request and made the following jurisdictional determinations:
Beaufort County Bridge 33 (B-5201] on NC99 over UT to Cuckolds Creek - Jurisdictional
Beaufort County Bridge 139 (B-5205) on SR1626 over Intercepting Canal -Jurisdictional
Beaufort County Bridge 141 (B-5204) on SR1626 over UT to Pantego Creek -Non-Jurisdictional
Beaufort County Bridge 157 (B-5203) on SR1532 over Acre Swamp -Non-Jurisdictional
Pamlico County Bridge 18 on SR1316 over Trent Creek -Jurisdictional
I have also flagged out the coastal wetlands on Pamlico 18 as you requested. If I can be of further assistance with any of these
projects, please let me know.
Have a good weekend!
Stephen
***** Note new E-mail Address is: Stephen. [e-mail] *****
E-mail correspondence to and from this address may be subject to the North Carolina Public Records
Law and may be disclosed to third parties.
file://G:~PROJECTS~BEAiIFORT1B5201~PetmitsUurisdictional Ca11s~Beaufort 33 Jurisdictional Determina... 4/27/2011

V
B-5201 BEAUFORT 33
BRIDGE REPLACEMENT
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Projen Tracking No. (Internal UreJ
11-03-0042
NO SURVEY REQUIRED FORM
PROJECT WFORMATION
Project No: B-5201
WBS No: 45299. I.1
F.A. No.~ BRSTP-0099(8)
Federal (USAGE) Permit Required?
Project Description:
County. Beaufort
Document. PCE
Funding: ^ State ®Federal
® Yes ^ No Permit Type.• NWP3
Replace Bridge No. 33 on NC 99 over unnamed channel.
.SUMMARY OF CULTURAL RESOURCES REVIEW
Briejdescription ojreview activities, results of review, and conclusions:
Review of HPO quad maps, relevant background reports, historic designations roster, and indexes was
undertaken on March 30, 2011. Based on this review, [here were no existing NR, SL, LD, DE, or SS
properties in the Area of Potential Effects Beaufort County GIS mapping including aerial photography
and tax information revealed no structures more than 50 years old exists within the APE.
BrieJExplanation ojwhy the available information provides a reliable basis for reasonably predicting
shat there are no unidentified historic properties in the APE:
There are no structures more than 50 years old within the APE. Using HPO GIS website and Google
Street view, and the Beaufort County Tax Parcel Data provides reliable information regarding the
structures in the APE. These combined utilities are considered valid for the purposes of determining the
likelihood of historic resources being present.
SUPPORT DOCUMENTATION
See attached: Maps
FINDING BY NCDOT CULTURAL RESOURCES PROFESSIONAL
NO SURVEY REQUIRED
"Na Survey Required"/orm/or Minor bnnspongnon Projenr as Qmtrfird in the 700] Progromnratic Agreemrnl.
~ NCDOTArchoeology&HisroricA¢hrrccrurr Graups

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B-5201 BEAUFORT 33
BRLDGE REPLACEMENT
NC 99 OVER UN-NAMED CANAL
PANTEGO USGS QUAD MAPAND SHEET NUMBER 9 FIRM PANEL 7608 J
OF THE SOIL SURVEY OF BEA UFORT COUNTY MAP NUMBER 3720760800 J
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NO SURVEY REQUIRED FORM
Project Tracking No. (Internal UreJ
11-03-0042
PROJECT INFORMATION
Pro'ect No: B-5201 Coun Beaufort
WBS No: 45299. i.l Document: PCE
F.A. No: Funding: State Federal
Federal (USAGE) Permit
Required? Yes No Permit
Type: Nationwide
Project Description: Replace Bridge No. 33 on NC 99 over unnamed canal. Design plans show
the bridge will be replaced in-place with an off site detour. Area of Potential Effects (A.P.E.) is
18 meters (60 ft.) wide and 274 meters (900 feet) long.
SUMMARY OF CULTURAL RESOURCES REVIEW
Review included
examination of aerial photograph, topographic map, soil survey, and listings of previously .
recorded sites, previous azchaeological surveys, and previous environmental reviews at the
Office of State Archaeology. Aerial photograph shows the project area is wooded (swamp?) in
the northwest and northeast quadrants, and ditched agricultural fields in the southwest and
southeast quadrants. The unnamed ditch appears to have been artificially straightened.
Topographic map (Pantego, N.C.) shows extremely flat landforms in all quadrants, and poorly
drained soil in the northeast quadrant. Soil survey shows the soil next to the bridge is very
poorly drained Arapahoe fine sandy loam. There aze no previously recorded azchaeological sites
nearby, and the A.P.E. has not been previously surveyed for azchaeological sites. The A.P.E. has.
not been part of any projects that have been through environmental review.
predicting that there are no unidentired historic properties in the APE: The review indicates
the A.P.E. has little potential for azchaeological sites because it is surrounded by poorly drained
soil.
SUPPORT DOCUMENTATION
®Map(s), ^Previous Survey Info, ^Photos, ^Correspondence, ^Notes
FINDING BY NCDOT CULTURAL RESOURCES PROFESSIONAL
NO SURVEY REOUIRED Archaeology ^Historic Architecture
Caleb Smith ~x ~- 4/8/2011
NCDOT Cultural Resources Specialist
Date
"Na Survey Required"form fur Minor Transponasiun Projects m Uual fed in the 1007 Pmgmmmasic Agreement.
NCOOT Archaeology & Nularic Arohiieclure Groups

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