20110883 Ver 1_Application_20110923

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STATE OF NORTH CAROLINA
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U.S. Army Corps of Engineers
Regulatory Pield Office
Post Off ice Box 1000
Washington, N.C. 27889-1000
Attention: Bill Biddlecome
September 22, 201 I
EUGENE A. CONTI, 1R.
$FCRIiT,\kV
~ ~: 0883
Subject Request for a NW 3 permit for pipe replacement on NC 12, 0.006 miles southeast of SR 1233, in
Breton, Dare County.
fhc North Carolina Department of Transportation is requesting a NW 3 permit for pipe
replacement on NC 12 in Darc County. The pipe is located approximately 0.006 miles southeast of SR
1233. "I'he pipes will be removed using NCDOT best management practices for pipe replacement. The
current pipes, 2 n 60" x 68'-fi" CMP will be replaced with 1 @ I6'-2" x 5'-I" x 63'-I"Aluminum Box
Culvert with aluminum headwalls with riprap at the Cour comers. The pipes are located in an unnamed
tributary to Cape Creek, a tributary to the ['amlico Sound. 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 meat 252-482-7977.
Sincerely,
Jerry Jennings
Division Engineer, Division One
Clay Willis
Division One Environmental Officer
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DEPARTMENT OF TRANSPORTATION icy
BEVERLY EAVES PERDUf_
GOVIift~OR
Cc: Darcy Ward, DWQ
Sonia Carillo, DWQ
1 13 Airport Drive, Suite 100, Edenton. NC 27932, Phone [phone], fax [phone]

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Office Use Only:
Corps action ID no.
DWO project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. A licant Information
1. Processing '
1 a. Type(s) of approval sought from the
Corps:
®Section 404 Permit ^ Section 10 Permit
1 b. Specify Nationwide Permit (NW P) number: NW 3 or General Permit (GP) number:
tc. Has the NWP or GP number been verified by the Corps? ^Yes ^ No
1d. Type(s) of approval sought from the DWO (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
1 f. 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
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 12 pipe replacement, 0.006 miles SE of SR 1233 Light Plant Rd
2b. County: Dare
2c. Nearest municipality /town: Buxton
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no: State Project no: 18.102811
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
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:
4b. Name:
4c. Business name
(if applicable): ~
'~
4d. Street address:
4e. City, slate, zip: ~
4f. Telephone no.:
4g. Fax no.: ~i
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 11
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):
1b. Site coordinates (in decimal degrees): Latitude: 35.26729 Longitude: - 75.53184
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: 0.01 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to UT to Cape Creek, a tributary to Pamlico Sound
proposed project:
2b. Water Quality Classification of nearest receiving water: SA, HOW
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:
NC 12 is a two lane paved road through the village of Buxton and the general land use is a mix of commercial, residential,
and vacant lots along NC 12.
3b. List the total estimated acreage of all existing wetlands on the property:
< 1 acre
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
60
3d. Explain the purpose of the proposed project:
To replace 2 failing pipes on NC 12.
3e. Describe the overall project in detail, including the type of equipment to be used:
The existing 2 @ 60" x 68'-6" corrugated metal pipes will be replaced with the proposed 1 @ 16'-2" x 5'-1" x 63'-
1"aluminum box culvert with aluminum headwalls with riprap on [he four corners for slope stabilization on its current
alignment. The current pipes will be removed entirely. 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. The work site will be dewatered during the
project.
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 ^ 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
1a. 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) DWO -non-404, other) (acres)
Tem ora T
W 1 ®P ^ T headwall coastal fringe ^ Yes ®Corps 0.0002
installation ®No ®DWQ
W2 ^ P ^ T ^ Yes ^Corps
^ No ^DWQ
W3 ^ P ^ T ^ Yes ^Corps
^ No ^DWQ
W4 ^ P ^ T ^ Yes ^Corps
^ Nc ^ DWO
W5 ^ P ^ T ^ Yes ^Corps
^ No ^ DWO
W6 ^ P ^ T ^ Yes ^Corps
^ No ^ DWO
2g. Total wetland impacts 0.0002
2h. Comments: There will be 10 sq. ft. of coastal fringe wetland at the toe of the slope on the southeast corner impacted from
the installation of the headwall.
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 DWO -non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 ^ P ^ T ^ PER ^Corps
^ INT ^DWQ
S2 ^ P ^ T ^ PER ^Corps
^ INT ^ DWO
S3 ^ P ^ T ^ PER ^Corps
^ INT ^DWQ
S4 ^ P ^ T ^ PER ^Corps
^ INT ^ DWO
S5 ^ P ^ T ^ PER ^Corps
^ INT ^DWQ
S6 ^ P ^ T ^ PER ^Corps
^ INT ^ DWO
3h. Total stream and tributary impacts 0
3i. Comments:
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.
Open water
impact number-
Permanent (P) or
Tem ora T 4b.
Name of waterbody
(if applicable) 4c.

Type of impact 4d.

Waterbody type 4e.

Area of impact (acres)
01 ®P ^ T UT to Cape Creek fill (riprap) canal 0.001
02 ^P^T
03 ^P^T
04 ^P^T
4f. To[al open water impacts 0.0010
4g. Comments: There will be 45 sq. ft. of open water impact resulting from riprap being placed on the northwest corner for
slope stabilization between the headwall and an existing bulkhead.
5. Pond or Lake Construction
If and or lake construction ro osed, then com lete the chart below.
5a.

PondlD Sb.

Proposed use or purpose 5c.
Wetland Impacts (acres) 5d.
Stream Impacts (feet) 5e.
Upland
(acres)
number of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
Sf. To[al
5g. Comments:
5h. Is a dam high hazard permit required?
^ Yes ^ No If yes, permit ID no:
Si. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
Page 6 of 11
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 im acts require miti anon, then ou MUST fll 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)
Tem orar T im act re wired?
B1 ^P^T ^Yes
^ No
62 ^P^T ^Yes
^ No
B3 ^P^T ^Yes
^ No
6h. Total buffer impacts
6i. Comments:
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
erasion 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 ^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
^ Payment to in-lieu fee program
project?
^ 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 7 of 11
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 permittee 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 irnpact 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:
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 Mana ement Plan
2a . What is the overall percent imperviousness of this project? n/a
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, 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
^ DWO 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
^ USMP
apply (check all that apply): ^ Water Supply Watershed
^ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ^Yes ^ No
attached?
4. DWQ Stormwater 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: 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) of 11
PCN Form -Version 1.3 December 10. 2008 Version

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 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 ^ 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
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 Essintial Fish Habitat List
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?
North Carolina Natural Heritage List
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in aFEMA-designated 100-year floodplain? ®Yes ^ No
Sb. 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
Ryan Shook 9/22/11
ApplicanUAgent's Printed Name ApplicanUAgent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant
is rovided.
Page 1 1 of 11
PCN Form -Version 1.3 December 10, 2008 Version

Dare County NC 12 pipe replacement
_ 0.06 mi. SE of SR 1233 Liaht Plant Rd
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