20110805 Ver 1_Application_20110829

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110805 Office Use Only:
Corps action ID no.
DWQ project no.
.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification C Form
A. A ticant Information
1. Processing
la. Type(s) of approval sought from the

Corps:
®Section 404 Permit El Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ? Yes ® No
l d- Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification - Regular ? Non404 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:
? 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
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below. ? Yes N No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: NC 102 Pitt County Pipe Replacement Over Un-Named Tributary of Clayroot Swamp
WBS Element Number 2CR.10741.9
2b. County: Pitt County
2c. Nearest municipality / town: Ayden
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
project no: WBS Element Number 2CR.10741.9
3. Owner Information
3a. Name(s) on Recorded Deed: North Carolina Department of Transportation
3b. Deed Book and Page No. WA
3c. Responsible Party (for LLC if
applicable): WA
3d. Street address: 105 Pactolus Highway NC 33 P.O. Box 1587
3e. City, state, zip: Greenville, NC 27835
3f. Telephone no.: 252-830-3490
3g. Fax no.: 252-830-3341
3h. Email address: [e-mail]
Page 1 of 10
PCN Form -Version 1.3 December 10, 2008 Version
r .. ,
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
(d applicable): North Carolina Depratment of Transportation
4d. Street address: P.O. Box 1587
4e. City, state, zip: Greenville, NC 27835
4f. Telephone no.: 252-830-3490
4g. Fax no.: 252-830-3341
4h. Email address: [e-mail]
5. Agent(Consultant Information (If applicable)
5a. Name: N/A
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 10
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): N/A
Latitude: N 35.418717 Longitude: - W
1b. Site coordinates (in decimal degrees): 77.271563
(DD.DDDODD) (-DD.DDDDDD)
1c. Property size: WA acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Clayroot Swamp
proposed project:
2b. Water Quality Classification of nearest receiving water. C;Sw;NSW
2c. River basin: Neuse Middle Neuse 03020202
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:
Woods and Agriculture
3b. List the total estimated acreage of all existing wetlands on the property:
N/A
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
60' Stream is a part of a Larger System
3d. Explain the purpose of the proposed project:
The Existing Pipe has deteoriated and needs to be replaced.
3e. Describe the overall project in detail, including the type of equipment to be used:
The Existing 90'-48" CMP will be replaced with a Proposed 76'-6" x 12'-3" x 7'-3" CMAP with Headwalls and One
Wingwall
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: NCDOT
Name (f known): Jay Johnson Other.
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
August, 2011
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.
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 3 of 10
PCN Form -Version 1.3 December 10, 2008.Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
® Wetlands ? Streams - tributaries ® Buffers
? Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number- Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary
W1 ? P ? T ? Yes ? Corps
? No ? DWQ
W2 ? P ? T ? Yes ? Corps
? No ? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts 0
2h. Comments: No 404 Wetland Impacts
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ - non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
Un-Named ® PER ? Corps
'
'
S1 ? P ®T Dewatering Device Tributary of ? INT ® DWQ 10 32
Clayroot Swamp

S2 ?P?T ? PER ? Corps
0
?INT ?DWQ
S3 ? P ? T ? PER ? Corps 0
? INT ? DWQ
Un-Named ® PER ? Corps
'
'
S4 ? P ®T Dewatering Device Tributary of ?INT ®DWQ 10 32
Clayroot Swamp
S5 ? PEI T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER [-I Corps
? INT ? DWQ
3h. Total stream and tributary impacts 64 LF
3i. Comments: 64 LF Stream Impacts For Dewatering Devices
Page 4 of 10
PCN Form - Version 1.3 December 10, 2008 Version
e ?
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.
Open water
impact number -
Permanent (P)
or Temporary 4b.
Name of waterbody
(if applicable) 4c.

Type of impact 4d.

Waterbody type 4e.

Area of impact (acres)
Ot ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts 0
4g. Comments: No Open Water Impacts
5. Pond or lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.

Pond ID 5b.

Proposed use or purpose of 5c.
Wetland Impacts (acres) 5d.
Stream Impacts (feet) 5e.
Upland
(acres)
number pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments: None
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
Page 5 of 10
PCN Form -Version 1.3 December 10, 2008 Version,

6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a.
® Neuse ?Tar-Pamlico ? Other: None
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) for Stream name mitigation (square feet) (square feet)
or Temporary impact required?

61 ? P ®T Staging Un-Named Tributary of ? Yes
1490
995
Area Clayroot Swamp ®No

B2 ®P ? T Fill,
Wingwall Un-Named Tributary of ? Yes
1420
1065
,
and Pipe Clayroot Swamp ® No
B3 ® P ? T Headwall Un-Named Tributary of ? Yes 1585 1100
Clayroot Swamp ® No
6h. Total buffer impacts
6i. Comments: See Page 6-A for Totals
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
Wetland Impacts have been minimized to the extent feasible, with impacts occurring only where necessary to accommodate
the Proposed Pipe, Wingwall,and Headwalls
I b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Use of existing roadway to operate construction equipment; no equipment will enter wetlands.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ? Yes ® No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps
? Mitigation bank
2c. If yes, which mitigation option will be used for this project? ? 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
Page 6 of 10 .
PCN Form - Version 1.3 December 10, 2008 Version
I ' • ,
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a.
® Neuse ?Tar-Pamlico ? Other: None
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) for Stream name mitigation (square feet) (square feet)
or Temporary impact required?

61 ®P ? T B4
Headwall Un-Named Tributary of ? Yes
1650 Sq. Ft.
1125 Sq. Ft.
and Fill Clayroot Swamp No
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts 6145 Sq. Ft. 4285 Sq. Ft.
6i. Comments: Buffer Zone 1 Impacts = 0.14 Acres Buffer Zone 2 Impacts = 0.10 Acres
D. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
U
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ? Yes ® No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps
? Mitigation bank
2c. If yes, which mitigation option will be used for this project? ? 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
to ?$
Page Wof 10
PCN Form -Version 1.3 December 10, 2008 Version
.. >
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 pennittee responsible mitigation plan, provide a description of the proposed mitigation plan.
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ®No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required: None
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).
N/A '
6h. Comments:
Page 7 of 10
PCN Form - Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a . 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: Sheet Flow through the Vegetated Shoulders and Temporary Silt
Fence will be used to treat Stormwater Run-Off From the Road. The Existing 18" ® Yes ? No
Pipe will remain in place in B2 and the Existing roadside ditches will not be
moved. Installation will be done in Low/No Flow conditions and Sift Bags will be
used to control sediment loss and turbidity.
2. Stormwater Management Plan
2a . What is the overall percent imperviousness of this project? N/A Roadway/Bridge Project %
2b . Does this project require a Stonnwater 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:
Sheet Flow through the Vegetated Shoulders and Temporary Silt Fence Fence will be used to treat Stor mwater Run-Off
From the Road. The Existing 18" Pipe will remain in place in B2 and the Existing roadside ditches will not be moved.
Installation will be done in Low/No Flow conditions and Silt Bags will be used to control sediment loss and turbidity.
? 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
? NSW
3b . Which of the following locally-implemented stormwater management programs ? USMP
apply (check all that apply): ? Water Supply Watershed
? Other: N/A
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ® No
attached?
4. DWQ Stormwater Program Review
? Coastal counties
? HQW
4a. Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply): ? Session Law 2006-246
® Other: NPDES Permit
4b. Has the approved Stormwater Management Plan with proof of approval been
? Yes ® No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stonnwater Management Plan meet the appropriate requirements? ? Yes ? No
Page 8 of 10
PCN Form - Version 1.3 December 10, 2008 Version

5b. Have all of the 401 Unit submittal requirements been met? ? Yes ? No
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la . Does the project involve an expenditure of public (federal/state/local) funds or the ®Yes ? No
use of public (federal/state) land?
1b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ? Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. If you answered "yes' to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
?Yes ? No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Weiland 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.
N/A
Page 9 of 10
PCN Form - Version 1.3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or ? Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ® No
impacts?
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?
On-Site Habitat Investigation The Natural Heritage Program, and the USFWS Website
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?
On-Site Investigation, The Natural Heritage Program, and The USFWS Website
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation ? Yes ®No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
SHPO Website
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No
Bb- If yes, explain how project meets FEMA requirements: Pipe designed to no-rise standards
8c. What source(s) did you use to make the floodplain determination? FEMA FIRM Maps
Jay B. Johnson 24,
Au2u
1t
0
1
Applicant/Agenrs Printed Name p cant/ ge s Signature Date
(Agent's sign is v id on an authorization letter from the applicant
is rovided.
Page 10 of 10
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NC 1021 PITT COUNTY PIPE REPLACEMENT
EXISTING 80'x 48" RCP -,
PROPOSED 12'-3"x 7--3"x 76'-6" PLATED ARCHED PIPE - -? -
r
WITH HEAD WALLS
GARDNERVILLE USGS QUAD MAP
SHEET NUMBER 75-A OF THE
FIRM PANEL 5600 K
SOIL SURVEYOF PITT COUNTY
MAP NUMBER 3 720560000 K
MIDDLE NEUSE 03020202 CLAYROOT SWAMP C,Sw; NSW
AUGUST 3, 2011 WBS ELEMENT NUMBER 2CR.10741.9
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k Rd
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Y=611801.8140
X= 2514930.3083
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N35 -25I-07 ,a
W 77^-161-181I
N35.418717 DEGREES
1 inch = 2.000 feet - i W77.271563 DEGREES
- 0 750 1,500 3,000 4,500 6,000
Feet 'I I o. n 1
NC 102, PITT COUNTY PIPE REPLACEMENT
EXISTING 80'x 48" RCP
PROPOSED 12'-3"x 7'--3" x 76'--6" PLATED ARCHED PIPE
WITH HEADWALLS
GARDNERVILLE USGS QUAD MAP
SHEET NUMBER 75-A OF THE
SOIL SURVEYOFPITT COUNTY FIRM PANEL 5600 K
MIDDLE NEUSE 03020202 MAP NUMBER 3720560000 K
CLAYROOT SWAMP CSw;NSW
AUGUST 3, 2011 WBS ELEMENT NUMBER 2CR.10741.9
GasWns 96
0179
p?1\ Pda?s Rd
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1 inch= 2,000 feet
Grover Smith Rd

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PIPE REPLACEMENT
Y= 611801.8140
X= 2514930.3083
N35 A -25'-07"
W 77^-16'--18"
N 35.418717 DEGREES
W 77.271563 DEGREES
0 750 1,500 3.000 4,500 6,000
Fe