20121073 Ver 1_Application_20121126

} � STATE
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVFRNOR
November 15 2012
U S Army Corps of Engineers
Regulatory Field Office
Post Office Box 1000
Washington N C 27889 1000
Attention Bill Biddlecome
EUGENE A CONTI JR
SECRETARY
2c0 1 21 0 73
Subject Request for a NW 14 permit for bridge replaced with culvert on SR 1210 Snowden Rd in Currrtuck
County
The North Carolina Department of Transportation is requesting a NW 14 permit for a bridge to
culvert replacement on SR 1210 Snowden Rd in Currituck County The pipe is located 100 west of the
intersection of SR 1210 and NC 34 The bridge will be removed using NCDOT best management practices
for bridge demolition The current bridge 20 x 26 will be replaced with 1 @ 20 -4 x 4 6 x 40 6
Aluminum Box Culvert with Aluminum Headwalls and riprap on each end The pipe is located in an
unnamed tributary (canal) to Cowells Creek 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
contact Ryan Shook at 252 482 7977
Sincerely
Jerry Jennings
Division Engineer Division One
Clay Willis
Division One Environmental Officer
Cc Garcy Ward DWQ
Sonia Carillo DWQ
113 Airport Drive Suite 100 Edenton NC 27932 Phone [phone] Fax [phone]

,
'1414�
Office Use Only
Corps action ID no
DWQ project no
Form Version 1 3 Dec 10 2008
Page 1 of 11
PCN Form — Version 1 3 December 10 2008 Version
Pre - Construction Notification PCN Form
A Applicant Information
1
Processing
la
Type(s) of approval sought from the
Corps
®Section 404 Permit El Section 10 Permit
lb
Specify Nationwide Permit (NWP) number NW 14 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)
® 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
1 h
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2
Project Information
2a
Name of project
Bridge # 13 on SR 1210 Snowden Rd
2b
County
Currituck
2c
Nearest municipality / town
Sligo
2d
Subdivision name
2e
NCDOT only T I P or state
project no
176P 1 R 8
3
Owner Information
3a
Name(s) on Recorded Deed
NCDOT R O W
3b
Deed Book and Page No
3c
Responsible Party (for LLC if
applicable)
3d
Street address
3e
City state zip
Edenton NC 27932
3f
Telephone no
252 482 7977
3g
Fax no
252 482 8722
3h
Email address
rlshook @ncdot gov
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
Ryan Shook
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 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 36 43197 Longitude 7609141
(DD DDDDDD) (DD DDDDDD)
1 c Property size
0 5 acres
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
Cowelis Creek
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
Existing concrete bridge # 13 over UT (canal) to Cowelis Creek on SR 1210 Land use is primarily agricultural and rural
residential
3b 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
60 of canal within the ROW
3d Explain the purpose of the proposed project
Replace an existing concrete bridge that is in poor condition with an Aluminum Box Culvert
3e Describe the overall project in detail including the type of equipment to be used
The existing structure is a single span 20 foot long x 26 wide bridge composed of concrete deck on wooden joists and
end bents Existing bents and piles will be entirely removed The proposed structure is 1 @ 20 4 x 4 6 x 40 6
Aluminum Box Culvert with Aluminum Structural Plate Headwalls on each end Riprap is also being proposed at the four
corners for slope stabilization on the transition from the road shoulder to the headwalls The new structure will be built on
the same alignment The road will be temporarily closed and traffic detoured along an alternate route
4 Jurisdictional Determinations
4a Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
El Yes ®No El Unknown
project (including all prior phases) in the pasty
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
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 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
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
31 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
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
UT to Cowells
Fill
canal
0 018
Creek
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
417 Total open water impacts
4g Comments 803 sq ft (0 018 ac) of impacts are a result fill from the installation of box culvert
5 Pond or Lake Construction
If pond 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
517 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 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 any 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
B1 ❑P ❑T
-required
❑Yes
❑ No
B2 ❑P ❑T
El Yes
❑ No
B3 ❑ P ❑ T
❑ 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
The box culvert design has minimized permanent impacts by utilizing headwalls on each end allowing for a shorter structure
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Pipe installation is going to stay on the existing alignment and the road will be closed during construction This will reduce
temporary impacts by not using an on site detour and keeping the road open NCDOT will follow our best management
practices during bridge demolition and pipe installation and install erosion control devices to prevent loss of sediment from the
project
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
y p g ram
❑ 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 of Using a Permettee 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 8of11
PCN Form — Version 1 3 December 10 2008 Version

E
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1
Diffuse Flow Plan
la
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?
NA %
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
NCDOT will use our Storm water best management practices in compliance with our state wide stormwater permit
❑ 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?
NA
❑ Phase II
3b
Which of the following locally implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other NA
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 NCDOT
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 9 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
❑ 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
None
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?
5c If yes indicate the USFWS Field Office you have contacted
❑ Raleigh
❑ Asheville
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Natural Heritage Data Base
6 Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitats
❑ Yes ® No
6b What data sources did you use to determine whether your site would impact Essential Fish Habitat?
National Marine Fisheries Data Base
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
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 Structure design complies with Hydraulic Engineer designs
8c What source(s) did you use to make the floodplain determination? NC Floodmaps
App) ant/Agent s Signature
Applicant/Agent s Printed Name
Date
(Agents signature is valid only if an authorization letter from the applicant
is provided )
Page 11 of 11
PCN Form — Version 1 3 December 10 2008 Version

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bridge replacement, 100'W. of NC 34
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