20090782 Ver 1_Application_20090714

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090782
Office Use Only.
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 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 (NWP) number: 14 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
1 g. 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: Carteret 40 BK-5103
2b. County: Carteret
2c. Nearest municipality / town: Newport
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
project no: 42554.1.1
3. Owner Information
3a. Name(s) on Recorded Deed: North Carolina Department of Transportation
3b. Deed Book and Page No. N/A
3c. Responsible Party (for LLC if
applicable): N/A
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:
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: Division 2 Environmental Officer
4b. Name: Jay B. Johnson .
4c. Business name
(if 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: NIA
5b.

5c. Business name
(if applicable):
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
1 a. Property identification no. (tax PIN or parcel ID): Carteret 40
Latitude: N 34.776964 Longitude: - W
1 b. Site coordinates (in decimal degrees): 76.882301
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: N/A acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Cedar Swamp Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: C
2c. River basin: White Oak
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:
SR 1140 is a two-lane state highway. Woodlands and Residential dominate the landscape.
3b. List the total estimated acreage of all existing wetlands on the property:
0.07 Acres This site is part of a larger adjacent wetland system
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
100' This site is part of a longer adjacent stream system
3d. Explain the purpose of the proposed project:
Bridge To Pipe Replacement; due to the age and condition of the existing bridge, it will be replaced by an Aluminum Box
Culvert
3e. Describe the overall project in detail, including the type of equipment to be used:
The Existing Timber Bridge will be replaced with 25'-4" x 9'-5" x 72' Aluminum Box Culvert with Headwalls.
Excavators,Dump Trucks,and Crane Trucks
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property I
? Yes ® No ? Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
El Preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Jay Johnson Other: NCDOT and NCDCM
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
March,2009
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):
N 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 Z P O T Fill Bottomland ® Yes N Corps 0.07
Hardwood Forest ? 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 11 Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts 0.07 Acres
(3036 Sq.Ft.)
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 N P ? T Pipe Bedding Cedar Swamp N PER ® Corps 20' 78'
Creek ? INT ? DWQ
S2 ? P N T De-Watering Cedar Swamp N PER ? Corps 20' 30'
Creek ? INT N DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
54 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
108
3h. Total stream and tributary impacts Linear
Feet
3i. Comments: Temporary Impacts are for the Proposed Sheet Piles and Pumping Operations for De-Watering the Site
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 -
Permanent (P) or (if applicable) Type of impact Waterbody type Area of impact (acres)
Temporary T
01 ®P ? T Cedar Swamp
Creek Culvert Placement Perennial Stream 0.00
02 ?P?T

03 ?P?T
04 ?P?T
4f. Total open water impacts 0.00
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.

Pond ID
Proposed use or purpose Wetland Impacts (acres) Stream Impacts (feet) Upland

number
f
d (acres)
o
pon
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total None
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:
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 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) or for Stream name mitigation (square feet) (square feet)
Temporary impact required?
81 ?P?T ?Yes
? No
B2 ? P ? T ? Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts None
6i. Comments:
D. Impact Justification and Mitigation
1. Avoidance and Minimization
la. 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 culvert.
1b. 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 ? P
t t
i
li
f

project? aymen
o
n-
eu
ee 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 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: 0.07 acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments: Mitigation Ratio is 1:1
5. Complete if Using a Perrnittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
The mitigation will be on-site and the plan will be coordinated through the USACOE
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 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
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.
Comments: Bridge Replacement project covered by NCDOT Statewide NPDES ? Yes ® No
Permit
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 Stormwater Management Plan? ? Yes ® No
2c . If this project DOES NOT require a Stormwater Management Plan, explain why: Covered by NCDOT Statewide NPDES
Permit
2d . If this project DOES require a Stormwater Management Plan, then provide a brief, na rrative description of the plan:
? 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?
? 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 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:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ? Yes ® No
S. 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)
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)?
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.1 300), 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.
N/A
Page 10 of 11
PCN Form - Version 1.3 December 10, 2008 Version
S. 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?
On-Site Habitat Investigation
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?
North Carolina Wildlife resources Commission
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?
NCSHPO
8. Flood Zone Designation (Corps Requirement)
Ba. Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No
8b. If yes, explain how project meets FEMA requirements: Culvert designed to no-rise standards
8c. What source(s) did you use to make the floodplain determination? FEMA FIRM Maps

A
i June 23, 2009
Applicant/Agent's Printed Name Signature
? Date
sjgnaturei
s
lyn
(Agent's orization letter from the applicant
d.
Page 11 of 11
PCN Form - Version 1.3 December 10, 2008 Version

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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P.O. BOX 1587, Greenville, N.C. 27835-1587
GOVERNOR
June 8, 2009
Mr. Stephen Lane,
Representative, Division of Coastal Management
North Carolina Department of Environment
And Natural Resources
Division of Coastal Management
Morehead City District
400 Commerce Avenue
Morehead City, North Carolina 28557
Attention: Mr. Stephen Lane
LYNDO TIPPETT
SECRETARY
Subject: CAMA Permit Application for BK-5103, Carteret 40,SR 1140, Roberts Road over
Cedar Swamp Creek Carteret County
WBS Element 42554. 1.1
Enclosed please find information regarding a Division 2 project located in Carteret
County. The project name is BK-5103, Carteret 40,SR 1140, Roberts Road over Cedar Swamp
Creek in Carteret County. The WBS Element Number is 42554. 1.1 . The proposed scope of
work is to realign the existing road from Station 16+00.00 -LPRO- to Station 23+00.00 -LPRO-
as shown on the attached plan sheet and replace the existing timber bridge at Station 20+00 -
LPRO- with a proposed 25'4" Span by 9'-5" Rise #86-E Aluminum Box Culvert with
Aluminum Headwalls. Due to the age and condition of the existing structure, The North Carolina
Department of Transportation deemed it necessary to replace the existing structure. The existing
pavement is 20' wide and the Average Daily Traffic (ADT) is 3,800 vehicles. Field
investigations indicate that traffic is running off the edge of the existing pavement, resulting in
pavement edge drop-offs. The Proposed Pavement width is 24'; thus reducing pavement edge
drop-offs.Therefore, the wider pavement and realignment will improve the geometry of the
roadway for the safety of the traveling public.
The amount of impervious surface has been reduced as much as possible. There will be
grass shoulders throughout the project that will filter runoff from the pavement and thus
minimize water quality impacts. The shoulder width at the proposed corrugated aluminum box
culvert will be approximately sixteen(16') on each side of the roadway and will provide
significant filtering of surface runoff prior to reaching Cedar Swamp Creek. Slopes of vegetated
roadside ditches are typically steeper that 3:1 but are consistent with the existing slopes. Flatter
slopes were not used due to the additional wetland impacts that would be created. There will be
DIVISION TWO • P.O. BOX 1587 • GREENVILLE, N.C. 27835
PHONE [phone] a FAX [phone]
no direct discharges into this creek. The project is located at Cedar Swamp Creek in Carteret
County and is in the White Oak River Sub-Basin (HUC 03020301) which is part of the Bogue-
Core Sounds (HUC 03020106). Cedar Swamp Creek Creek in not listed as Section 303 Impaired.
The main wetland complex through which the roadway is located, is dominated by a Bottomland
Hardwood Forest. Approximately 3,036 Square Feet (0.07 Acres) of 404 Wetland Impacts will
be filled by the proposed project. Mitigation has been arranged with the United States Army
Corps of Engineers; mitigation will be on-site and a 1:1 ration applied.The North Carolina
Wildlife Resources Commission has requested an in water work moratorium from February 15 to
June 15 and concurrence by the North Carolina Division of Marine Fisheries has occurred. As of
January 31,2008, the United States Fish and Wildlife Service lists several Federally Protected
Species for Carteret County. Please see attached table for those species. The North Carolina
Department of Environment and Natural Resources,Wilmington Regional Office,Division of
Water Quality has issued a Stormwater Permit Exclusion letter, a copy of which is included in
this application.
The North Carolina Department of Transportation requests that this project be authorized
by the issuance of a Coastal Area Management Act Major Development Permit. Please find
attached the completed DCM-MP-1 ,DCM-MP-2, and DCM-MP-5 Forms along with the
appropriate permit drawings and maps. The PS Form 3811,Certified Mail Receipts from the
adjacent property owner notifications are also included. Should you have any questions
regarding this information, please contact me at 252-830-3490 ext. 248.
Sincerely,
Y_4W_1
Jay Johnson
Environmental Officer
NCDOT, Division 2
DMSION TWO. P.O. BOX 1587 o GREENVILLE, N.C. 27835
PHONE (252) 830,-3490 o FAX [phone]
Form ®CM MP-5 (Bridges and Culverts, Page 2 of 4)
c. Type of culvert (construction material):
Corrugated Aluminum Arch Box Culvert
d. (i)Will proposed culvert replace an existing bridge?
OYes ?No
If yes,
(ii) Length of existing bridge: BY
(iii) Width of existing bridge: 25'
(iv) Navigation clearance underneath existing bridge:
(v) Will all, or a part of, the existing bridge be removed?
(Explain) All Of The Existing Bridge Will Be Removed
e. (i) Will proposed culvert replace an existing culvert?
?Yes ONo
If yes,
(ii) Length of existing culvert(s): _
(iii) Width of existing culvert(s):
(N) Height of the top of the existing culvert above the NHW or
NWL: _
(v) Will all, or a part of, the existing culvert be removed?
(Explain)
I. Length of proposed culvert: 72'
h. Height of the top of the proposed culvert above the NHW or NWL.
8.T
J. Will the proposed culvert affect navigation by redudng or
Increasing the existing navigable opening? Masi ONo
If yes, explain:
9. Width of proposed culvert: 22:E
1. Depth of culvert to be buried below existing bottom contour.
T
k. Will the proposed culvert affect existing water flow?
®Yes ?No
if yes, explain: The Culvert Will Increase The Volume of
Flow of Water Because There Are No Pilings In The
Stream For Debris To Become Lodged.
3. EXCAVATION and FILL ?Thissection not applicable
a. (1) Will the placement of the proposed bridge or culvert require any
excavation below the NHW or NWL? ®Yes ?No
If yes,
(ii) Avg. length of area to be excavated: 78'
(III) Avg. width of area to be excavated: 32'
(iv) Avg. depth of area to be excavated: 1_0'
(v) Amount of material to be excavated in cubic yams: 9 Cu.
Yds.
c. (i) Will the placement of the proposed bridge or culvert require any
high-ground excavation? ?Yes ONo
If yes,
(ii) Avg. length of area to be excavated:
(iii) Avg. width of area to be excavated:
(iv) Avg. depth of area to be excavated:
(v) Amount of material to be excavated in cubic yards:
b. (i) Will the placement of the proposed bridge or culvert require any
excavation within coastal wetlandshnarsh (CW), submerged
aquatic vegetation (SAV), shell bottom (SB), or other wetlands
(WL)? If any boxes are checked, provide the number of square
feet affected.
?CW _ ?SAV ?SB
OWL 040,S9, R. ?None
III) Describe the purpose of the excavation in these areas:
Excavation Prior To Back Filling For Culvert and
Roadway
Forage 0CM MP-5 (Bridges and Culverts, Page 3 of 4)
d. If the placement of the bridge or culvert involves any excavation, please complete the following:
(1) Location of the spoil disposal area: Temporary Spoil Area is in the Existing Road
(ii) Dimensions of the spoil disposal area: 100' x 200'
(iii) Do you claim title to the disposal area? ®Yes ?No (if no, attach a letter granting permission from the owner.)
(iv) Will the disposal area be available for future maintenance? ®Yes ?No
(v) Does the disposal area include any coastal wetlands/marsh (CM, submerged aquatic vegetation (SAVs), other wetands (WL), or shell
bottom (SB)?
?CW ?SAV ?WL ?SB ®None
If any boxes are checked, give dimensions if different from (ii) above.
(vi) Does the disposal area include any area below the NHW or NWL? ? ?Yes ®No
If yes, give dimensions if different from (ii) above.
e. (i) Will the placement of the proposed bridge or culvert result in any
fill (other than excavated material described in Item d above) to
6be placed below NHW or NWL? Oyes ?NO
If yes,
(ii) Avg. length of area to be filled: 78'
(iii) Avg. width of area to be filled: 30'
(iv) Purpose of fill: Pipe Bedding
f. (i) Will the placement of the proposed bridge or culvert result in any
fill (other than excavated material described in Item d above) to
be placed within coastal wetlands/marsh (CM, submerged
aquatic vegetation (SAV), shell bottom (SB), or other wetlands
(WL)? If any boxes are checked, provide the number of square
feet affected.
?CW ?SAV ?SB _
OWL 3,036 So. Ft. ?None
(ii) Describe the purpose of the excavation in these areas:
Fill Will Be Used To Build Shoulders and Roadway Fill
(i) Will the placement of the proposed bridge nor culvert result in any
fill (other than excavated material described in Item d above) to
be placed on high-ground? ®Yes ?No
If yes,
(ii) Avg. length of area to be filled: West 350' test 275'
(iii) Avg. width of area to be filled: 68'
(iv) Purpose of fin: Roadway Fill Material Placed in the
Existing Bridge Location and Roadway
4. GENERAL
a. Will the proposed project require the relocation of any existing
utility lines? ®Yes ?No
If yes, explain: Telephone Line will be relocated by
Erribarq. Embarq will pursue their environmental
permits.
If this portion of the proposed project has already received
approval from local authorities, please attach a copy of the
approval or certification.
b. Will the proposed. project require the construction of any temporary
detour structures? ?Yes ZNo
If yes, explain:
< Form continues on back*
Form DCM MP-5 (Bridges and Culverts, Page 4 of 4)
c. Will the proposed project require any work channels?
If yes, complete Form DCM-MP-2.
?Yes ®No
e. What type of construction equipment will be used (for example,
dragline, backhoe, or hydraulic dredge)?
Typical Bridge Construction Equipment
d. Now will excavated or fill material be kept on site and erosion
controlled?
Silt Fences and TRSC-A's will be used to retain sediment
on-site
f. Will wetlands be crossed in transporting equipment to project site?
?Yes ®No
If yes, explain steps that will be taken to avoid or minimize
environmental impacts.
g. Will the placement of the proposed bridge or culvert require any
shoreline stabilization? ®Yes ?No
If yes, complete form MP-2, Section 3 for Shoreline
Stabilization only.
June 8, 2009
Date
BK-5103 Carteret County Bridge Replacement SR 1140,Roberts
Road over Cedar Swamp Creek WBS Element Number
42554.1.1
Project Name
Jay B. Johnson
Applicant Name
Applicant na
°i?ou°?.ulvdv3n4OINI,If fe red m«,.:?oorrer.r o,..,, o...... c rocmarmmwrrermao_aao2-0w.ao,
WBS: 42554.1.1 TIP PROJECT: BK-5103

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CARTERET 40, BK-5103
SR 1140,ROBERTS ROAD OVER CEDAR SWAMP CREEK
WBS ELEMENT 42554
BRIDGE REPLA CEMENT WITHAL UMINUMCULVERT,, REALIGNMENT OFROAD,
GRADING, DRAINAGE, AND PAVING
MARCH 13, 2009
N
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150027
Rd
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Y= 380541.5116
X= 2635862.2801
N34^-46! 47"
W 76^-52'--56rr
N34.776964 DEGREES
W 76.882301 DEGREES
FIRM PANEL 6338
MAP NUMBER 3720633800J
Oakleaf Dr
1 10,000 5,000 0 10,000 Feet
G. CE Approval
TIP Project No. sx-5103
State Project No. 42554.1. 1
Federal-Aid Project No.
Project Description: (Include project scope and location. Attach location map.)
Type of work: Roadway realignment, bridge replacement with
corrugated aluminum box culvert, paving, grading, and drainage.
Location: SR 1140 (Roberts Rd), Bridge #40 at Cedar Swamp
Creek.
Categorical Exclusion Action Classification: (Check one)
X_ TYPE II(A)
TYPE II(B)
Approved:
-"7Q7
Dat Division En onm tal Of er
$ 09 Q... '// GI.? .
Da e Division perations Engine
qr'
For Type II(B) projects only:
Date Division Administrator
Federal Highway Administration
7
(14) Will the project require any stream relocations or channel
changes? X
SOCIAL, ECONOMIC, AND CULTURAL RESOURCES YES NO

(15) Will the project induce substantial impacts to planned
F
growth or land use for the area?
X
(16) Will the project require the relocation of any family or
business? X
(17) Will the project have a disproportionately high and adverse
human health and environmental effect on any minority or
low-income population? X
(18) If the project involves the acquisition of right of way, is the ?
amount of right of way acquisition considered minor? X
(19) Will the project involve any changes in access control? ?
X
(20) Will the project substantially alter the usefulness
and/or land use of adjacent property? X
(21) Will the project have an adverse effect on permanent
local traffic patterns or community cohesiveness? X
(22) Is the project included in an approved thoroughfare plan
and/or Transportation Improvement Program (and is, ?
therefore, in conformance with the Clean Air Act of 1990)? X
(23) Is the project anticipated to cause an increase in traffic
volumes? X
(24) Will traffic be maintained during construction using existing ?
roads, staged construction, or on-site detours? X
(25) If the project is a bridge replacement project, will the bridge
be replaced at its existing location (along the existing facility)
and will all construction proposed in association with the ?
bridge replacement project be contained on the existing facility? X
(26) Is there substantial controversy on social, economic, or
environmental grounds concerning the project? F-1 X
(27) Is the project consistent with all Federal, State, and local laws
relating to the environmental aspects of the project? X
(28) Will the project have an "effect" on structures/properties
eligible for or listed on the National Register of Historic Places? F X
5
j. Performing clear zone safety improvements including removing
hazards and flattening slopes
k. Implementing traffic aid systems, signals, and motorist aid
1. Installing bridge safety hardware including bridge rail retrofit
O Bridge rehabilitation, reconstruction, or replacement or the construction of
grade separation to replace existing at-grade railroad crossings.
a. Rehabilitating, reconstructing, or replacing bridge approach slabs
b. Rehabilitating or replacing bridge decks
c. Rehabilitating bridges including painting (no red lead paint), scour
repair, fender systems, and minor structural improvements
dO Replacing a bridge (structure and/or fill)
4. Transportation corridor fringe parking facilities.
5. Construction of new truck weigh stations or rest areas.
6. Approvals for disposal of excess right-of-way or for joint or limited use of
right-of-way, where the proposed use does not have significant adverse
impacts.
7. Approvals for changes in access control.
8. Construction of new bus storage and maintenance facilities in areas used
predominantly for industrial or transportation purposes where such
construction is not inconsistent with existing zoning and located on or near
a street with adequate capacity to handle anticipated bus and support
vehicle traffic.
9. Rehabilitation or reconstruction of existing rail and bus buildings and
ancillary facilities where only minor amounts of additional land are
required and there is not a substantial increase in the number of users.
10. Construction of bus transfer facilities (an open area consisting of
passenger shelters, boarding areas, kiosks and related street
improvements) when located in a commercial area or other high activity
center in which there is adequate street capacity for projected bus traffic.
11. Construction of rail storage and maintenance facilities in areas used
predominantly for industrial or transportation purposes where such
construction is not inconsistent with existing zoning and where there is no
significant noise impact on the surrounding community.
12. Acquisition of land for hardship or protective purposes, advance land
acquisition loans under section 3(b) of the UNIT Act. Hardship and
protective buying will be permitted only for a particular' parcel or a limited
number of parcels.. These types of land acquisition qualify for a CE only
where the acquisition will not limit the evaluation of alternatives,
including shifts in alignment for planned constriction projects, which may
be required in the NEPA process. No project development on such land
may proceed until the NEPA process has been completed.
(29) Will the project affect any archaeological remains which are ?
important to history or pre-history?
(30) Will the project require the use of Section 4(f) resources
(public parks, recreation lands, wildlife and waterfowl refuges,
historic sites, or historic bridges, as defined in Section 4(f) ?
of the U. S. Department of Transportation Act of 1966)?
(31) Will the project result in any conversion of assisted public
recreation sites or facilities to non-recreation uses, as defined
by Section 6(f) of the Land and Water Conservation Act ?
of 1965, as amended?
(32) Will the project involve construction in, across, or adjacent
to a river designated as a component of or proposed for
inclusion in the Natural System of Wild and Scenic Rivers?
F.
ng an umavorame responses in rE
supporting documentation may be
1-1
X
X
X
X
d be provided
as necessary.)
N/A
CATEGORICAL EXCLUSION ACTION CLASSIFICATION FORM
A.
B.
C.
TIP Project No.
State Project No.
Federal Project No.
BK-5103
42554.1.1
Project Description: (Include project scope and location and refer to the attached
project location map.)
Creek.
Type of work: Roadway realignment,?bridge replacement with
corrugated aluminum box culvert, paving, grading, and drainage.
Location: SR 1140 (Roberts Rd), Bridge #40 at Cedar Swamp
Purpose and Need:
Realignment of road/ bridge replacement needed to reduce
traffic accidents at existing bridge.
Proposed Improvements:
Circle one or more of the following Type II improvements which apply to the
project:
lO Modernization of a highway by resurfacing, restoration, rehabilitation,
reconstruction, adding shoulders, or adding auxiliary lanes (e.g., parking,
weaving, turning, climbing).
Restoring, Resurfacing, Rehabilitating, and Reconstructing
8 pavement (3R and 4R improvements)
b. Widening roadway and shoulders without adding through lanes
c. Modernizing gore treatments
d. Constructing lane improvements (merge, auxiliary, and turn lanes)
C. Adding shoulder drains
f Replacing and rehabilitating culverts, inlets, and drainage pipes,
including safety treatments
g. Providing driveway pipes
It. Performing minor bridge widening (less than one through lane)
2O Highway safety or traffic operations improvement projects including the
instal lation of ramp metering control devices and lighting.
a. Installing ramp metering devices
b. Installing lights
c. Adding or upgrading guardrail
d. Installing safety barriers including Jersey type barriers and pier
protection
C. Installing or replacing impact attenuators
f. Upgrading medians including adding or upgrading median barriers
Improving intersections including relocation and/or realignment
( h.) Making minor roadway realignment
?' Channelizing traffic
E. Threshold Criteria
The following evaluation of threshold criteria must be completed for Type II
l actions
ECOLOGICAL YES NO
i
(1)
Will the project have a substantial impact on any

F
unique or important natural resource?
X
(2) Does the project involve habitat where federally
listed endangered or threatened species may occur? F X
(3) Will the project affect anadromous fish?
F
X
(4) If the project involves wetlands, is the amount of
permanent and/or temporary wetland taking less than
one-third (I/3) of an acre and have all practicable measures

to avoid and minimize wetland takings been evaluated?
X ?
(5) Will the project requite the use of U. S. Forest Service lands?
?
X
(6) Will the quality of adjacent water resources be adversely
F
impacted by proposed construction activities? X
(7) Does the project involve waters classified as Outstanding Water ?
.
Resources (OWR) and/or High Quality Waters (HQW)? X
(8) Will the project require fill in waters of the United States
in any of the designated mountain trout counties? ? X
(9) Does the project involve any known underground storage
F
tanks (UST's) or hazardous materials sites? X
PERMITS AND COORDINATION YES NO
(10) If the project is located within a CAMA county, will the
project significantly affect the coastal zone and/or any
Area of Environmental Concern" (AEC)? ? X
(11) Does the project involve Coastal Barrier Resources Act

resources? ?
X
I
i (12)
Will a U. S. Coast Guard permit be required?
F
X
(13) Will the project result in the modification of any existing
regulatory floodway? X
4

SUMMARY OF AFFECTED PROPERTY OWNERS

TRACT
NUMBER PROPERTY
OWNER
ADDRESS

4523 RANDY J. RIGGS
etal 1208 RIPPLESTONB AVENUE
NORTH LAS VEGAS, NV 89031
0653 EDWARD L. M77.1_F.R 600 ROBERTS ROAD
NEWPORT, NC 28570

7119
ASHLEY N. ROBERTS 2173 US HIGHWAY 70 EAST
BEAUFORT, NC 28516

5283
GRNDY G. HARRIS 4525 VOA ROAD
WASHINGTON, NC 27889

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CARTERET 40, B8 5103
SR 1140,ROBERTS ROAD OVER CEDAR SWAMPCREEK
WBSELEMENT 42554
BR[L GE REPLACEMENT WITHALUi9INUM CULVERT,. REALIGNMENT OFROAD,
GRADING, DRAINAGE, AND PAVING
MARCH 13, 2009

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NMA 46! 7"
W76 A 42'46"
N34.776964 DEGREES
W 76 882301 DEGREES
FIRMPANEL 6338
MAPNUMBER 3 72 0633 800J
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4
APPLICATION for
Major Development Permit
(last revised 111227106)
North Carolina DIVISION OF COASTAL MANAGEMENT
1. Primary Applicant/ Landowner Information
Business Name Project Name (if applicable)
North Carolina Department Of Transportation Carteret 40, BK-5103,Bridge To Culvert Replacement, SR
1140, Roberts Road,Carteret County
Applicant 1: First Name MI Last Name
Jay B. Johnson
Applicant 2: First Name MI Last Name
If additional applicants, please attach an additional page(s) with names li sted.
Mailing Address
PC Box
City
State
1587
1 Greenville NC
ZIP Country - Phone No. FAX No.
278351587 us 252-830-3490 ext. 248 252-830-3341
Street Address (d ddierent frrem above) City state ZIP
Email
[e-mail]
2. AgentlContractor Information
Business Name
Agentl Contractor 1: First Name MI Last Name
Agent/ Contractor 2: First Name MI Last Name
Mailing Address PC Box City
State
ZIP Phone No. 1
-
- ext. Phone No. 2
- - ext.
FAX No. Contractor #
Street Addre ss (if different from above) City state ZIP
Email -
<Folm continues on back>
Forth DCM MF-2
EXCAVATION and FILL
(Except for bridges and culverts)
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of the Joint
Application that relate to this proposed project. Please include all supplemental information.
Describe below the purpose of proposed excavation and/or fill activities. All values should be given in feet
Access Other
Channel Canal Boat Basin Boat Ramp Rock Groin Rock (excluding
(NLW or Breakwater shoreline
NWL stabilization
Length
Width
Avg. Existing NA NA
Depth
Final Project NA NA
Depth
1. EXCAVATION 0This section not applicable
a. Amount of material to be excavated from below NHW or NWL in Is Type of material to be excavated.
cubic yards.
c. (i) Does the area to be excavated include coastal wetlandsimareh
(CW), submerged aquatic vegetation (SAV), shell bottom (SB),
or other wetlands (WL)? If any boxes are checked, provide the
number of square feet affected.
?CW ?SAV ?SB
?WL ?None
(11) Describe the purpose of the excavation in these areas:
it. High-ground excavation in cubic yards.
0This section not applicable
a.
area.
area.
c. (I) Do you claim title to disposal area?
?Yes ?No ?NA
(it) If no, attach a letter granting permission from the owner,
d. (i) Willa disposal area be available forfuture maintenance?
?Yes ?No ?NA
(ii) If yes, where?
e. (i) Does the disposal area include any coastal wetlandslmarsh f. (i) Does the disposal include any area in the water?
(CM, submerged aquatic vegetation (SAV), shell bottom (SB), ?Yes ?NO ?NA
or other wetlands (WL)? If any boxes are checked, provide the
number of square feet affected. (ii) If yes, how much water area is affected?
?CW ?SAV ?SB _
?WL T ?None
(if) Describe the purpose of disposal in these areas:
3. SHORELINE STABILIZATION ?This section not applicable
(If development is a wood groin, use MP4 - Structures)
Form ®CM MP-2 (Excavation and Fill, Page 2 of 2)
a. Type of shoreline stabilization: b. Length: North Headwall 31.5' North Winowalls 27' South
?Bulkhead ?Riprap ?Bmakwater/Sill ®Other Headwall 31.5' South Headwall 27" Total Lenoth= 11T
Headwalls and Wingwalls Width: V
c. Average distance watenvard of NHW or NWL: 4'
e. Type of stabilization material:
Aluminum Headwalls and Wingwalls
g. Number of square feet of fill to be placed below water level.
Bulkhead backfill _ Riprap _
Breakwater/Sill Other 14' North and South 15' = 29'
x V Wile = 67 Sa. FL
i. Source of fill material.
(Excluding Shoreline Stabilization)
a.
If yes,
(ii) Amount of material to be placed in the water 1.604 So Ft.
(iii) Dimensions of fill area Approximately 72'x 15'
(iv) Purpose of fill
Back Fill for the Culvert and Bedding for the Culvert
d. Maximum distance waterward of NHW or NWL: 5'
f. () Has them been shoreline erosion during preceding 12
months?
?Yes ®No ?NA
(ii) If yes, state amount of erosion and source of erosion amount
information.
h. Type of fill material.
Aluminum Headwalls,Wingwalls, and #57 Washed Slone
?This section not applicable
submerged aquatic vegetation (SAV), shell bottom (SB), or
other wetlands (WL)? If any boxes am checked, provide the
number of square fleet affected.
?CW _ ?SAV _ ?SB
OWL 3.036 So. Ft. ?None
(ii) Describe the purpose of the fill in these areas:
Roadway
Fill and Shoulder Material
15. GENERAL
a. How will excavated or fill material be kept on site and erosion b. What type of construction equipment will be used (e.g., dragline,
controlled? backhos, or hydraulic dredge)?
Slit Fences and TRSC-A's Typical Road Construction Equipment
c. (1) Will navigational aids be required as a result of the project? d. (i) Will wetlands be crossed in transporting equipment to project
?Yes ®No ?NA site? ?Yes ®No ?NA
(ii) If yes, explain what type and how they will be implemented. (ii) If yes, explain steps that will be taken to avoid or minimize
environmental impacts.
June 8, 2009 Ap
plicant Name
Date
BK-5103, SR 1140, Roberts Road Bridge replacement WBS
Element Number 42554.1.1 plicant Signature
Jay B. Johnson
For DCM MP-1 (Page 2 of 5)
APPLICATION for
Major Development Perk
3. Project Location
County (can be mulfiple) Street Address State Rd. #
Carteret SR 1140, Roberts Road
Subdivision Name city State Zip
Phone No. Lot No.(s) (d many, attach additional page with list)
ext.
a. In which NC river basin is the project located? b. Name of body of water nearest to proposed project
White Oak Cedar Swamp Creek
c. Is the water body identified in (b) above, natural or manmade? d. Name the closest major water body to the proposed project site.
®Natural ?Manmade ?Unknown Newport River
e. Is proposed work within city limits or planning jurisdiction? f. If applicable, list the planning jurisdiction or city limit the proposed
?Yes ONO work falls within.
4. Site Description
a . Total length of shoreline on the tract (ft) b. Size of entire tract (sq.ft)
North 96' South 94' 0.97 Acres
c. Size of individual lot(s) o. Approximate elevation of tract above NHW (normal high water) or
N/A. I NWL (normal water level)
(d many lot sizes, please attach additional page with a list) 10.0' ?NHW or ®NWL
e. Vegetation on tract
Maintained Road Side Grasses AND Bottomland Hardwood Species
E Man-made features and uses now on tract
Bridge and Roadway
g. Identify and describe the existing land uses ad'ace h to the proposed project site.
Residential and Woods
h. How does local government zone the tract? I. Is the proposed project consistent with the applicable zoning?
N/A (Attach zoning compliance certificate, if applicable)
?Yes ?No ®NA
j. Is the proposed activity part of an urban waterfront redevelopment proposal? ?Yes No
k. Hasa professional archaeological assessment been done for the tract? If yes, attach a copy. ®Yes ?No NA
If yes, by whom? Project Reviewed By SHPO
1. Is the proposed project located in a National Registered Historic District or does it involve a Yes No NA
National Register listed or eligible property?
<Fonn continues on next page>
m. (I) Are mere wetlands on
(ii) Are there coastal wetlands on the site?
?Yes ONO
(iii) If yes to either (i) or (ii) above, has a delineation been conducted? ®Yes ?No
(Attach documentation, if available)
Form DCM MP-1 (Page 3 of 5)
APPLICATION for
Major Development Permit
n. Describe existing wastewater treatment facilities.
WA
o. Describe existing drinking water supply source.
WA
p. Describe existing storm water management or treatment systems.
N/A
5. Activities and Impacts
a. Will the project be for commercial, public, or private user Commemial Public/Government
?PrivatelCommunity b. Give a brief description of purpose, use, and daily operations of the project when complete.
Due To The Age And Condition Of The Existing Structure, Carteret 40 Will be replaced with one 25'-4" x 9'-5" Corrugated
Aluminum Arch Type Culvert, Bituminous Coated, with Headwalls.
c. Describe the proposed construction methodology, types of construction equipment to be used during construction, the number of each type
of equipment and where it is to be stored.
The Existing Structure Will be Replaced with one 25'-4" x 9'-5" CAABC and Fill Material for Shoulder Construction will be
Installed. Construction will be from the Top Down. Typical Roadway Construction Equipment Will Be Used, Induding,But Not
Limited To Tracked Excavators,Dump Trucks, Flat-Bed Truciks,Badk-Hoes,And Boom Trucks.
it. List all development activities you propose.
The Proposed Centerline From PC Station 16+00.00 -LPRO- To PT Station 23+00.00 -LPRO- Will Shift To The Right. The
Shoulder Will Be Built As Well As Fill Slopes.The Existing Bridge Will Be Replaced With A Culvert From Station 19+78.12 -
LPRO- To Station 20+05.00 -LPRO-
e. Are the proposed activities maintenance of an existing project, new work, or both? Both
f. What Is the approximate total disturbed land area resulting from the proposed project? 0.97 ?Sq.Ft or ®Acres
g. Will the proposed project encroach on any public easement, public accessway or other area Yes No NA
that the public has established we of?
h. Describe location and type of existing and proposed discharges to waters of the state.
Stormwater will be treated by the vegetated shoulders.
1. Will wastewater or stormwater be discharged Into a wetland? Was Nc NA
If yes, will this discharged water be of the same salinity as the receiving water? ®Yes ?No ?NA
J. Is there any mitigation proposed? Yes No NA
If yes, attach a mitigation proposal.
<Form continues on back>
6. Addidonallnfonnadon
In addition to this completed application form, (MP-1) the following items below, If applicable, must be submitted in order for the application
package to be complete. Items (a) - (0 are always applicable to any ma/or development application. Please consult the application
instruction booklet on how to property prepare the required dams below.
a. A project narrative.
b. An accurate, dated work plat (including plan view and cross-sectional drawings) drawn to scale. Please give the present status of the
proposed project. Is any portion already complete? If previously authorized work, dearly indicate on maps, plats, drawings to distinguish
between work completed and proposed.
c. A site or location map that is sufficiently detailed to guide agency personnel unfamiliar with the area to the site.
Form DCM MP-1 (Page 4 of 5)
APPLICATION for
Major Development Permit
d. A copy of the deed (with state application only) or other instrument under which the applicant claims title to the affected properties.
e. The appropriate application fee. Check or money order made payable to DENR.
f. A list of the names and complete addresses of the adjacent waterfront (riparian) landowners and signed return receipts as proof that such
owners have received a copy of the application and plats by certified mail. Such landowners must be advised that they have 30 days in
which to submit comments on the proposed project to the Division of Coastal Management.
Name Randy J. Riggs
Phone No.
Address 1208 Ripplestone Avenue North Las Vegas, NV 89031
Name Edward L. Miller
Phone No.
Address 600 Roberts Road Newport, NC 28570
Name Grady G. Hams
Phone No. 4525 VOA Road Washington, NC 27889
Address Ashley N. Roberts 2173 US Highway 70 Fast Beaufort, NC 28516
g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, perni ttee, and Issuing dates.
WA
h. Signed consultant or agent authorization form, if applicable.
I. Wetland delineation, if necessary. ,
j. A signed AEC hazard notice for projects in oceanfront and inlet areas. (Must be signed by properly owner)
IL A statement of compliance with the N.C. Environmental Policy Act (N.C.G.S. 113A 1-10), if necessary. ff the project Involves expenditure
of public funds or use of public lands, attach a statement documenting compliance with the North Carolina Environmental Policy Act.
I understand mat any permit Issues in response to tms application wm allow only me oevelopment oescnoec in me application.
The project will be subject to the conditions and restrictions contained in the permit.
I certify that I am authorized to grant, and do In fact grant permission to representatives of state and federal review agencies to
enter on the aforementioned lands in connection with avaluatingintorntation related to this permit application and follow-up
monitoring of the project.
I further certify that the information provided in this application is truthful to the best of my knowledge.
Date June 8, 2009 Print Name _Jay B. Johnson
Signature
Please indicate application attachments pertaining to your proposed project.
®DCM MP-2 Excavation and Fill Information ®DCM MP-5 Bridges and Culverts
?DCM MP-3 Upland Development
?DCM MP-4 Structures Information
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