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STATE OF NORTH CAROLINA
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DEPARTMENT OF TRANSPORTATION a
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BEVERLY EAVES PERDUE EUGENE A. CONTI, JR.
GOVERNOR SECRETARY
May 6, 2009
U.S. Army Corps of Engineers
Regulatory Field Office ®?
Post Office Box 1000
Washington, N.C. 27889-1000
Attention: Bill Biddlecome
Subject: Request for a NW 3 permit for pipe replacement on Old Doctors Road, Buxton in Dare County.
The North Carolina Department of Transportation is requesting a NW 3 permit for pipe
replacement on Old Doctors Rd in Dare County. The pipe is located approximately 0.14 miles from the
intersection of NC 12. The pipe will be removed using NCDOT best management practices for pipe
replacement. The current pipes, 3 @ 40' x 24" CMP will be replaced with 3@ 40'x 42" CAA. The pipes
are located in Peters Ditch, a tributary to the Pamlico 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 me at 252-482-7977.
Sincerely,
Jerry Jennings
Division Engineer, Division One
Clay Willis
` \
Division One Environmental Officer
Cc: Garcy Ward, DWQ
Sonia Gregory, 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 1.0 November 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps:
® Section 404 Permit ? Section 10 Permit
1b. Specify Nationwide Permit (NW P) number: 3 or General Permit (GP) number:
1c. Has the NW P 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
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 ® 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: Old Doctors Road Pipe Replacement
2b. County: Dare
2c. Nearest municipality / town: Buxton
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
project no: 36648
3. Owner Information
3a. Name on Recorded Deed:
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 11
PCN Form - Version 1.0 November 2008 Version
Section A. Applicant Information, continued
4. Applicant Information (if different from owner)
4a. Applicant is: ® Agent ? Other, specify:
4b. Name: Clay Willis, Division Environmental Officer
4c. Business name
(if applicable): NCDOT
4d. Street address: 113 Airport Or, Suite 100
4e. City, state, zip: Edenton, NC 27932
4f. Telephone no.: 252-482-7977
4g. Fax no.: 252-482-8722
4h. Email address: [e-mail]
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 - November 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): 35.26167'N -75.56333'W
1c. Property size: 0.1 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project: Peters Ditch, Tributary to Pamlico Sound
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:
Unpaved 10'-12' road through Buxton Woods Coastal Reserve. General land use is Maritime Forest.
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:
Open water, likely a slow draining freshwater wetland system, canal dug to improve residential drainage.
3d. Explain the purpose of the proposed project:
To replace structurally deficient pipes.
3e. Describe the overall project in detail, including the type of equipment to be used:
Replace 3@ 40'X 24" Corrugated Metal Pipe with the proposed 3@ 40'x 42" Corrugated Aluminum Arch with rip rap
shoulders on both ends on its current alignment. The current pipes will be removed entirely. Proper fill will be used to
bring road to existing height. The proposed pipe diameter is larger to help restore the tributary to more natural flow
regimes. 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 /
project (including all prior phases) in the past?
? Yes ® No ? Unknown
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
? Preliminary ? Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Agency/Consultant Company:
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
this project (including all prior phases) in the past? ? Yes ® No ? Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
61b. If yes, explain.
Page 3 of 11
PCN Form - Version 1.0 November 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 Type of wetland Forested (Corps - 404, 10 Area of impact (acres)
Permanent (P) or impact (if known) DWQ - non-404, other)
Temporary T
W1 ? P ? T ? Yes ? No ? Corps
? DWQ
W2 ? P ? T ? Yes ? No ? Corps
? DWQ
W3 ? P ? T ? Yes ? No ? Corps
? DWQ
W4 ? P ? T ? Yes ? No ? Corps
? DWQ
W5 ? P ? T ? Yes ? No ? Corps
? DWQ
W6 ? P ? T ? Yes ? No ? Corps
? DWQ
2g. Total wetland impacts 0
2h. Comments: There will be no wetland imacts associated with this project.
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.
Stream impact Type of Stream name Perennial (PER) or Average stream width (feet) Impact
number - impact intermittent (INT)? length
Permanent (P) or (linear feet)
Temporary (T)
S1 ? P ? T ? PER ? INT
S2 ? P ? T ? PER ? INT
S3 ? P ? T ? PER ? INT
S4 ? P ? T ? PER ? INT
S5 ?P?T ?PER ?INT
S6 ? P ? T ? PER ? INT
3g. Total stream and tributary impacts 0
3h. Comments: There will be no stream impacts associated with this project.
Page 4 of 11
PCN Form - Version 1.0 November 2008 Version
C. Proposed Impacts Inventory, continued
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 individual) list all o en water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of
impact number waterbody Type of impact Waterbody type Area of impact (acres)
- Permanent (if
(P) or applicable)
Temporary T
01 ®P ? T Peter's
Ditch
fill (rip rap)
canal
0.002
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts 0.002
4g. Comments: Proposed pipes will be the same length as existing with rip rap around the ends to stabilize the shoulders.
Page 5 of 11
PCN Form - November 2008 Version
C. Proposed Impacts Inventory, continued
5. Pond or Lake Construction
if and or lake construction pro osed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or (acres)
number purpose of pond
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:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
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 ou MUST fill out Section D of this form.
6a.
? Neuse ?Tor-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6e. 6f. 6g.
Buffer impact
number - 7Ren Buffer Zone 1 impact (square Zone 2 impact
Permanent (P) Stream name mitigation feet) (square feet)
or Temporary required?
T
81 ?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 - November 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 State? ? 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

El Payment to in-lieu fee program
? Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
31b. 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
41b. Stream mitigation requested: 0 linear feet
4c. If using stream mitigation, stream temperature: warm, cool, cold
4d. Buffer mitigation requested (DWQ only): 0 square feet
4e. Riparian wetland mitigation requested: 0 acres
4f. Non-riparian wetland mitigation requested: 0 acres
4g. Coastal (tidal) wetland mitigation requested: 0 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 1.0 November 2008 Version
D. Impact Justification and Mitigation, continued
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 Reason for impact Total impact
(square feet) Multiplier Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
Total buffer mitigation required:
6c. 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).
6d. Comments:
Page 8 of 11
PCN Form - November 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 N No
within one of the NC Riparian Buffer Protection Rules?
1b . If yes, then is a diffuse flow plan included? ? Yes ?'No
2: Determination if the Project Requires a Stormwater Management Plan
2a . Does the project require a Non404 Jurisdictional General Permit? ? Yes N No
2b . Is the project subject to General Certification 3704 or 3705? ? Yes E No
3. Determination of Stormwater Review Jurisdiction
3a. Is this project subject to any of the following state-implemented stormwater ? Coastal counties
management programs (check all that apply)? ? HOW
? ORW
If so, attach one copy of the approval letter from the DWQ and one copy of the ? Session Law 2006-246
approved stormwater management plan. ? Other:
3b. In which local government's jurisdiction is this project?
3c. Is this local government certified to implement a state stormwater program? ? Yes ? No
If so, attach one copy of the approval letter from the local government and one copy
of the approved stormwater management plan (or one copy of the approved
Stormwater management plan stamped as approved).
4. Information Required for DWQ 401 Unit Stormwater Review
4a. What is the overall percent imperviousness according to the most current site plan? Impervious a rea will remain the
same.
4b. Does this project contain any areas that meet the criteria for "high density" per ? Yes N No
General Certifications 3704 and 3705?
4c. If the site is over 24% impervious and/or contains high density areas, then provide a brief narrative description of the
stormwater management plan.
4d. Has a completed BMP Supplement Form with all required items been submitted ? Yes ? No
for each stormwater BMP?
Page 9 of 11
PCN Form - Version 1.0 November 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?
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
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.
Page 10 of 11
PCN Form - Version 1.0 November 2008 Version
F. Supplementary Information, continued
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 USFW S 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?
North Carolina Natural Heritage Program
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No
61b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Marine Fisheries Essential 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
6. 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: pipe replacement
8c. What source(s) did you use to make the floodplain determination? North Carolina Floodplain Mapping Information System
Clay Willis 14L G/??
Applicant/Agent's Printed Name Ap llicanUAgent's Signature
(Agent's signature is valid only if an authorization letter from the applicant Date
is provided.)
Page 11 of 11
PCN Form - November 2008 Version
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