20110668 Ver 1_Application_20110713

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STATE OF NORTI-I CAROLINA
avosr???,?-
EUGENE A. CONTI.H
SECRETARY
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
July 1, 2011
U.S. Army Corps of Engineers
Regulatory Field Office
Post Office Box 1000
Washington, N.C. 27889-1000
Attention: Bill Biddlecome
11 06168
Subject: Request for a NW 3 permit for pipe replacement on SR 1469 Sandy Rd in Pasquotank County.
The North Carolina Department of Transportation is requesting a NW 3 permit for pipe
replacement on SR 1469 Sandy Rd in Pasquotank County. The pipe is located at the intersection of SR
1354 Millpond Rd. The pipe will be removed using NCDOT best management practices for pipe
replacement. The current pipes 1 @ 35'x 54" CMP will be replaced with 1 n 80' x 81" x 59" CAAP with
riprap on both ends. The pipes are located in an unnamed tributary to Newland Drainage Canal. The PCN.
vicinity map, and permit drawings are included with this letter. If you need any additional information or
have any questions concerning this project please call me at 252-482-7977.
Sincerely,
Jerry Jennings
Division Engineer, Division One
Clay Willis A:4- dh'
Division One Environ ental Officer
Cc: Garcy Ward, DWQ
Sonia Carillo, DWQ
113 Airport Drive, Suite 100, Edenton, NC 27932, Phone [phone], Fax [phone]
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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the
Corps:
®Section 404 Permit ? Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: NW 3 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ? Yes ? No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
N 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
le. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
N Yes ? No For the record only for Corps Permit:

? Yes N No
If. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes N No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below. N Yes ? No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes Z No
2. Project Information
2a. Name of project: SR 1469 Sandy Rd
2b. County: Pasquotank
2c. Nearest municipality / town: Elizabeth City
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no:
State Project no: 16.207011
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT
3b. Deed Book and Page No. n/a
3c. Responsible Party (for LLC if
applicable): NCDOT Division One
3d. Street address: 113 Airport Drive, Suite 100
3e. City, state, zip: Edenton, NC 27932
3f. Telephone no.: 252-482-7977
3g. Fax no.: 252-482-8722
31h. Email address: [e-mail]
Page I of 11
PCN Form - Version 1.3 December 10, 2008 Version
?r
4. Applicant Information (if different from owner)
4a. Applicant is, ? Agent ? Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: '
51b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. 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
la. Property identification no. (tax PIN or parcel ID):
1 b. Site coordinates (in decimal degrees): Latitude: 36.39338 Longitude: - 76.38140 'II
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: 0.1 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Newland Drainage Canal, tributary to Little River
proposed project:
2b. Water Quality Classification of nearest receiving water: C, SW
2c. River basin: Pasquotank
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
A secondary gravel road with some residential homes in the nearby area with the remainder of the land use being actively
cultivated agricultural fields.
31b. List the total estimated acreage of all existing wetlands on the property:
0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
100', UT to Newland Drainage Canal and is a channelized canal that parallels the adjacent road, SR 1354, and eventually
makes its way to Newland Drainage Canal through a system of maintained agricultural drainage features.
3d. Explain the purpose of the proposed project:
To replace a failing pipe on SR 1469 and to improve the intersection for commercial traffic to an agricultural business
located on SR 1469.
3e. Describe the overall project in detail, including the type of equipment to be used:
The existing 35' X 54" corrugated metal pipe will be replaced with the proposed 80' x 81" x 59" corrugated aluminum arch
pipe with riprap on both ends on its current alignment. The current pipe will be removed entirely. The footprint of the
road will be widened to increase radius for intersection. This will include a wider roadbed and increasing the shoulder
width. Proper fill will be used to bring road to existing height. Heavy equipment that will be used will be an excavator,
backhoe, and dump trucks. .
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property / ? Yes ®No ? Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type ? Preliminary? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for
? Unknown
? yes ® No
this project (including all prior phases) in the past?
51b. 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
61b. If yes, explain.
Page 4 of 11
PCN Form - Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
ta. Which sections were completed below for your project (check all that apply):
? Wetlands ® Streams - tributaries ? Buffers
? Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number- Type of impact Type of wetland Forested (Corps -404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
W1 ? P ? T ? Yes ? Corps
? No ? DWQ
W2 ? P ? T ? Yes ? Corps
? No ? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2e. Total wetland impacts 0
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number- (PER) or (Corps-404, 10 stream length
Permanent (P) or intermittent DWQ - non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 ®P ? T fill (pipe, nprap, UT to Newland ® PER ® Corps 15 46
earthen material) Drainage Canal ? INT ® DWQ
S2 ? P ? T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ?DWQ
3h. Total stream and tributary impacts 46
3i. Comments: 671 square feet of impact to canal resulting from fill
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 Waterbody type Area of impact (acres)
Permanent (P) or
Temporary T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts - 0
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5L Total
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWO)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse ?Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T impact required?
61 ?P?T ?Yes
? No
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts
6i. Comments:
Page 6 of 11
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.
Pipe replacement is going to stay on the existing alignment and the road will be closed during construction. This will reduce
temporary impacts to wetlands and the stream by not using an on-site detour and keeping the road open..
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Methods of construction will be concurrent with NCDOT Best Management Practices for replacement of pipes and for soil and
erosion control .
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 Stale? ? 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

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

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires ? Yes Z 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:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 8 of 11
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?
1 b . If yes, then is a diffuse flow plan included? If no
explain why.
, ? Yes ? No
Comments:
2. Stormwater Management Plan
2a . What is the overall percent imperviousness of this project? n/a %
21b . 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, na rrative description of the plan:
NCDOT state stormwater permit for highway system is applicable. NCDOT will follow guidelines for Erosion and
Sediment Control.
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ® DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review
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
apply (check all that apply): ? USMP
? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review
? Coastal counties
? HOW
4a. Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply): ? Session Law 2006-246
® Other: NCDOT stormwater
permit, No. NCS000250
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
5b. Have all of the 401 Unit submittal requirements been met? ? Yes ? No
Page 9 of 11
PCN Form - Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. 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)?
1c. If you answered 'yes' to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
? Yes ? No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered 'yes' to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
No wastewater will be created from this project.
Page 10 of 11
PCN Form - Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or 1:1 yes ®No
habitat?
5b. Have you checked with the USFW S concerning Endangered Species Act ? Yes ® No
impacts?
El Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Natural Heritage database
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Marine Fisheries
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation ? Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
71b. What data sources did you use to determine whether your site would impact historic or archeological resources?
North Carolina Natural Heritage List
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No
8b. If yes, explain how project meets FEMA requirements: Based on project scope, project was not reviewed for FEMA
requirements.
8c. What source(s) did you use to make the floodplain determination? NC Flood Mapping Information System
Cla
Willis do?
y
Applicant/Agent's Printed Name Appl' ant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant
is provided.
Page I I of 11
PCN Form - Version 1.3 December 10, 2008 Version
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