20120467 Ver 1_Application_20120509

MAY — 9 2012
I)ENR *ATERQUALfTY STATE OF NORTH CAROLINA
rtaNps ANp s7atn+wATER AW DEPARTMENT OF TRANSPORTATION
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-L BEVERLY EAVES PERDUE EUGENE A CONTI JR
GOVERNOR SECRETARY
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WA
May 2 2012
U S Army Corps of Engineers
Regulatory Field Office
Post Office Box 1000
Washington N C 27889 1000
Attent nn R 11 R rrhilarnmP
Him''
Subject Request for a NW 3 permit for pipe replacement on SR 1208 Kitty Hawk Rd Kitty Hawk Dare
County
The North Carolina Department of Transportation is requesting a NW 3 permit for pipe
replacement on SR 1208 Kitty Hawk Rd in Dare County The pipe is located approximately 0 416 miles
west of the eastern intersection of SR 1206 The pipe will be removed using NCDOT best management
practices for pipe replacement The current pipe I @ 40 x 24 CMP will be replaced with 1 @ 50 x 30
CAP with riprap on both ends The pipe is located in an unnamed tributary (canal) to Kitty Hawk Bay
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
vl Officer
Division One En i o enta
Cc Garcy Ward DWQ
Sonia Carillo DW Q
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
Page 1 of 10
PCN Form — Version 1 3 December 10 2008 Version
Pre - Construction Notification (PCN) Form
A Applicant Information
1
Processing
1 a
Type(s) of approval sought from the
Corps
®Section 404 Permit El Section 10 Permit
1b
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
1d
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
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 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
SR 1208 Kitty Hawk Rd pipe replacement
2b
County
Dare
2c
Nearest municipality / town
Kitty Hawk
2d
Subdivision name
2e
NCDOT only T I P or state
project no
State Project no 1 202811
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
tcwillis @ncdot gov
Page 1 of 10
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 state zip
4f Telephone no
4g Fax no
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 10
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)
Latitude 36 071 Longitude 7572483
1 b Site coordinates (in decimal degrees)
(DD DDDDDD) ( DD DDDDDD)
1 c Property size
0 01 acres
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
UT to Kitty Hawk Bay
proposed protect
2b Water Quality Classification of nearest receiving water
SC
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 protect at the time of this
application
A secondary paved road with residential homes
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 a failing pipe on SR 1208 0 416 miles west of the eastern intersection of SR 1206
3e Describe the overall protect in detail including the type of equipment to be used
The existing 1 @ 40 X 24 corrugated metal pipe will be replaced with the proposed 1 @ 50 x 30 corrugated aluminum
pipe with nprap on both ends on its current alignment The current pipe 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
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
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
la 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
2g 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
❑ PER
® Corps
❑ 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
0
31 Comments
Page 4 of 10
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
Temporary T
4b
Name of waterbody
(if applicable)
4c
Type of impact
4d
Waterbody type
4e
Area of Impact (acres)
01 ®P ❑ T
UT to Kitty Hawk
Bay
fill (pipe) & nprap
Canal
00017
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
4f Total open water impacts
00017
4g Comments 72 5 sq ft of open water Impact resulting from 10 additional feet of pipe and nprap for slope stabilization
5 Pond or Lake Construction
If nnnri n InL o �nnct nt nn nr�npgcr1 than rmmnlato tha chart hpirw/
5a
Pond ID
number
5b
Proposed use or purpose
of pond
5c
Wetland Impacts (acres)
5d
Stream Impacts (feet)
5e
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f Total
5g Comments
5h Is a dam high hazard permit required
❑ Yes ❑ No If yes permit ID no
51 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 any impacts require mitigation then you MUST fill out Section D of this form
6a
❑ Neuse El Tar Pamlico El 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?
B1 ❑P ❑T
❑Yes
❑ No
B2 ❑P ❑T
El Yes
❑ No
B3 ❑P ❑T
El Yes
❑ No
6h Total buffer impacts
61 Comments
D Impact Justification and Mitigation
1 Avoidance and Minimization
1 a 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
❑ 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 6 of 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 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 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
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 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?
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 %
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 nroiect DOES require a Stormwater Management Plan then movide a brief narrative 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 11
❑ NSW
3b
Which of the following locally implemented stormwater management programs
❑ 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 Program Review
❑ Coastal counties
❑ HQW
4a
Which of the following state implemented stormwater management programs apply
❑ ORW
❑ Session Law 2006 246
(check all that apply)
® Other NCDOT stormwater
permit No NCS000250
4b
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
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 8 of 10
PCN Form — Version 1 3 December 10 2008 Version

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?
lb
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
❑Yes
El 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 Surtace Water or Wetiana Stanaaras
❑ res
ivy
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 protect or available capacity of the subject facility
No wastewater will be created from this project
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?
❑ 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)?
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)
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
Clay Willis
J4
?
/s /v-
Applicant/Agent s Printed Name
Date
Applicant/ ent s Signature
(Agents signature is valid only if n authorization letter from the applicant
is provided
Page 10 of 10
PCN Form — Version 1 3 December 10 2008 Version

Dare County SR 1208 Kitty Hawk Rd
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