20030455 Ver 1_COMPLETE FILE_20030414

Otr W ATF9
O Q Michael F. Easley
?O G Governor
?2 r William G. Ross, Jr., Secretary
y Department of Environment and Natural Resources
4 Alan W. Klimek, PE, Director
Division of Water Quality
June 24, 2003
DWQ Project # 03-0455
Pamlico County
Darrell Henry
32640 Chestnut Ridge Road
Ohio, NC 44039
Subject Property: Henry Family Residence, Lot 8, Mason Bay SD, Merritt, NC
Mason Creek [03-04-13, 27-150-9, SC Sw HQW (high quality) NSW (nutrient sensitive)]
APPROVAL of 401 Water Quality Certification (GC3402) with ADDITIONAL CONDITIONS
Dear Mr. Henry:
You have our approval, in accordance with the attached conditions, to fill 0.10 acres of fresh water wetlands at.the subject
property as described in your application received by the Division of Water Quality (DWQ) Wetlands/401 Unit on April 14,
2003. After reviewing your application, we have determined that the wetland impacts are covered by the Division of Water
Quality (DWQ) General Water Quality Certification Number 3402 (GC3402). This Certification allows you to Nationwide
Permit No. 18 when issued by the US Army Corps of Engineers (USACE). In addition, you should get or otherwise
comply with any other federal, state and local requirements before you go ahead with your project including (but not
limited to) erosion and sediment control regulations and CAMA. Also, this approval will expire when the accompanying
404 permit expires unless otherwise specified in the General Certification. .
This approval is only valid for the purpose and design that you described in your application. If you change your project,
you must notify us and you may be required to send us a new application. If the property is sold, the new owner must be
given a copy of this Certification and approval letter and is thereby responsible for complying with all conditions. If total
fills for this project (now or in the future) exceed one acre of wetland or 150 linear feet of stream, compensatory mitigation
may be required as described in 15A NCAC 2H .0506 (h). For this approval to be valid, you must follow the conditions
listed in the attached certification and any additional conditions listed below.
Conditions:
1. Diffuse Flow
An additional condition is that all stormwater shall be directed as diffuse flow at non-erosive velocities through the
protected stream buffers and will not re-concentrate before discharging into the stream or coastal wetlands as
identified within 15A NCAC 2B.0233(5).
2. Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, and any
subsequent modifications, the applicant is required to return the attached certificate of completion to the 401/Wetlands
Unit, North Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650.
3. Water Quality Certification (s)
The proposed project must comply with all of the conditions of General Water Quality Certification(s) (GC) 3402.
If you do not accept any of the conditions of this Certification (associated with the approved water impacts), you may ask
for an adjudicatory hearing. You must act within 60 days of the date that you receive this letter. To ask for a hearing,
send a written petition, which conforms to Chapter 150B of the North Carolina General Statutes to the Office of
Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 27611-7447. This certification and its conditions are final and
binding unless you ask for a hearing.
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
919-733-1786 (phone), 919-733-6893 (fax), http://h2o.enr.state.nc.us/ncwetlands/
Page 2 of 2
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. This letter
does not approve any impacts to riparian buffers protected under the Neuse Buffer Rule as described within 15A
NCAC 2B .0233. We understand that you have chose to apply for your pier/dock at a later date. This letter does
not approve any impacts to buffers or waters associated with construction of the pier/dock. If you have any
questions, please telephone Bob Zarzecki at 919-733=9726.
Sincerely,
VNICaann W. Klimek, P.E.
DWQ, Director
Attachment: GC 3402
Cc: DCM Morehead City District Office
USACE Washington Regulatory Field Office
Tom Steffens, DWQ Washington Regional Office
File Copy
Central Files
DWO030455
June 24, 2003
bz
April 29, 2003
I spoke with Mr. Henry and he explained that the dock was not being built at this time.
He will submit a separate application for those impacts at a later date. The road
apparently has already been constructed and he is now applying for an NWP 18 for 0.1
acres of additional fill around the road. These wetlands are SW and thus require written
concurrence. I didn't ask but there is no indication of a previous application for the road
construction. He apparently has been in touch with Tracy Wheeler from CAMA and Scott
Jones of the COE. I spoke with Scott briefly. He was familiar with the site, and I will
contact him later to discuss the matter more in depth. I left a message for Tracy but
haven't heard back from her. I left a message for Mr. Henry indicating that he should
send in more detailed site plans as requested and that we would pass his application on to
the region. Furthermore I told him to contact me if he had further questions.
ES
A

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan Klimek, P.E., Director Division of Water Quality
April 23, 2003
DWQ # 03-0455
Pamlico County
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Darrell Henry
32640 Chestnut Ridge Road
Nor Ridgeville, Ohio 44039
Dear Mr. Henry:
On April 14, 2003 the Division of Water Quality (DWQ) was notified by receipt of your
application regarding your plan to fill waters for the purpose of residential construction in Pamlico
County. Approval from DWQ is required to disturb these areas. Please provide 7 copies of the
following information and refer to the DWQ # listed above in your reply. Please show these on maps of
suitable scale (for instance 1" = 100 feet) so we can begin to determine your projects' compliance with
15A NCAC 2H.0500.
1. Please provide a detailed site plan with all wetland impacts including fills slopes on site plan.
2. Please indicate proposed lot layout as over lays on the site plan.
3. Please provide details for the dock design and specify potential impacts to waters (Mason
Creek).
4. This Office believes that the road leading to the house can be moved or reconfigured to avoid
the impacts to the forested wetland indicated on the lot map. Please revise the plans to avoid
the impacts.
Please telephone Ed Schwartzman at 919-733-1787 if you have any questions or would require
copies of our rules or procedural materials. This project will remain on hold as incomplete in
accordance with 15A NCAC 2H .0505(c). The processing time for this application will begin when this
information is received. If we do not hear from you by writing within three (3) weeks we will assume
you no longer want to pursue the project and will consider it withdrawn.
Sincerely,
'C??A-
ohn R. Dorney
401 Water Quality Certification Program
JRD/bs
cc: Washington DWQ Regional Office
Washington Corps of Engineers
Central Files
File Copy

N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address) _
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (http://h2o.enr.state.nc.us/ncwetlands
Office Use Only:
USACE Action ID No.
any particular item
1. Processing
4Fftersion May 2002
DWQ No.
not applicable to this project, please enter'
FILE COPY IV.11 ', ¢0 t
APR 14 2003
1. Check all of the approval(s) requested for this project: ??T-? (;??QN
Section 404 Permit ? Rip'aatr?d??e?'73uffer Rules
? Section 10 Permit ? Isolated Wetlan [Tenni! ?frw?
Q 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requestek GC3362 GC3365 GC3351
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here:
II. Applicant Information
Owner/Applicant Information
Name: parrPll Hanr
Mailing Address: 32640 Chestnut Ridge RD
North Ridgeville
Ohio 44039
Telephone Number: 440 327 6543 Fax Number: same
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires i nformation t o b e s ubmitted o n sheets no t arger than 11 b y 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Private Residence " Henry Family "
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): J05-6-8
4. Location
County: Pamlico Nearest Town: merrir
Subdivision name (include phase/lot number): Mason Bay lot' 8
Directions to site (include road numbers, landmarks, etc.): NCSR 324 4.25 miles, nff N('55
lot next to first major bridge headed toward "1Flnranr-c (NCRS1 324aka
Florence Whortonville rd)
5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): 3.93
7. Nearest body of water (stream/river/sound/ocean/lake): Mason Creek on Bay River
S_ River Basin:
Neuse
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/mays/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Wooded lot next water with several fingers of
not completely draining areas protruding towards the middle of the
property across drive area.
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: To clear
trees as needed improve driveway, excavate for house, grade small areas,
limited fill where needed, construction of private home with boat dockage-----.
(eamt) backhoe bobcat concrete trucks an(9 = nmpL_= nGaahlP ln? triirk _
11. Explain the purpose of the proposed work: private home with improved driveway
and boat dockage
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
Septic installed 1997 record 1552 permit 3030
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
1980000291 Gr 1-4rJ 1;maA Hmo rnc+r,@neo during home constuction
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
1. Provide a written description of the proposed impacts: Possible silt during constrution
and water disturbance during dockage piling installation
2. Individually list wetland impacts below:
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
const=ruction 0 es 140 a Salt Marsh
C .t 11
excavation 0 It 11
if 130-140
fill .10 140 low areas
__?_ t... _ a 1:...:...,7 .... ...e ..l.?..:..e.t nls -Glln fill
* List each impact separately and identity temporary impacts. impacts mcIuuo, uul MU IIVL uuu.w w. u.vvuo..••. •. -1 b, b••^-•- b. .... .
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
.s 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at htty://www.fcma.gov.
**' List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing
Total area of wetland impact proposed:
on the property: 1.33 acres
3. Individually list all intermittent and perennial stream inYpacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name'?* Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)

List each impact separately and identity temporary impacts. lmpacts tnc?uac, ULIL aac RUL uuu.w - vw•.v.w ........».............. ••r •-r+
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.gov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.toi)ozonc.com,
www.manouest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 130
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres
Name Wate)
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.
Mason Creek Bay River

* List each impact separately and identify temporary impacts. impacts inciune, out are not urrutea to: nu, ezcavat?vn, ure??g?ng,
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
silt fence straw and landscaping
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
httv://h2o.enr.state.ne.us/ncwetlands/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at httv://h2o.enr.state.nc.us/wm/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. T he applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified, within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify, )?
Yes ? No ® If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
' Zone i extends out 30 feet perpendicular from near bank of channel; Lone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B.0242 or.0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Gray and Rainwater holding tanks to reuse as needed for 1anr9.r;;pJnn
XII. Sewage Disposal (required by DWQ)
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.
septic installed 1997
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No M
Is this an after-the-fact permit application?
- Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

Applicant/Agent's Signature Date
(Agent's signature is valid only if an a o nation letter from the applicant is provided.)
Page 12 of 12

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NOTE:
This drawing was created for preliminary planning and Is not a
complete descrlptlon of the lot shown. It is not for subdivision
description. It is notforrecordation, conveyance or final design. See
subdivision plat and restrictive covenants for further description.
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Mason Bay
LOT #8
Pamlico County, NC
Legend
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t PAMLICO COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
CERTIFICATE OF COMPLETION
OPERATION PERMIT
ISSUED Tb; :.:.,ON PERMIT#
ADDRESS: RECORD # `1552
MAP # JOS-6-8
PHONE: SR # OFF 1324
LOCATION: S/D ON 1324 BEFORE FLORENCE INTERSECTION
MASON BAY ESTATES: LOT # 8
WATER SUPPLY:
PUBLIC
( ) PRIVATE: feet from closest point of septic system
JUSTALLER: t;?rlexr r' an. t R,;_ ? , CODE # t
APPROVAL: This.system has been inspected by the signing Sanitarian and
has been APPROVED as shown on the:
( ) PLOT PLAN
FINAL PLOT
( ) ELECTRICAL INSPECTIONS APPROVAL RECEIVED: SEE ATTACHMENT
OPERATIONAL PERMIT./RESTRICTIONS AND'STIPULATIONS:
( ) This system Will be inspected time(s) a year
( )'WATER;CONSERVATION DEVICES OR-,METHODS
Comments':
( ) ADDITIONAL:

:«*«««««««««««««««««««««««««««i FINAL PLOT «««««««««««««««*««««««««««*««

1'..ROVAL DATE."
SANITARIAN..' ?.?- '
NOTE: THE OWNER OR CONTROLLER. OF A`FPR?PERTY IS RESPONSIBLE FOR THE
MAINTENANCE OF A GROUND ABSORPTION SEPTIC SYSTEM IN A MANNER
WHICH WILL NOT EMIT EFFLUENT OR CONTAMINATION TO GROUND SURFACE
OR SURFACE WATERS. VIOLATIONS OF THIS LAW ARE PUNISHABLE AS A
MISDEMEANOR UNDER G.S.13OA-23&25. (Ref.1961)

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~ FINAL PLAT OFS
MASON BAY
?I WEYERHAEUSER . ?MLICO NUMBER 39
w11 tiiM i•r .r.•
arI t, i. "n". TWAtat BO011 1
a[u t,Pp [tui[ . iyy gym... •.r ..ri /IUMBER E iD ICO COUNTY. M.C.
i....rro.w •rrtW r.w SCALE: 1' - • I00' I PA DATES SEPT S[PT. 2 E7. 194f
K ...r r.M• Mrr.r •
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rnr.r. OWMER[
SURVEYED BYS .. y. WEYERHAEUSER AM ESTATE COMPANY
.N • rN .•• ALAN SELL SURVEYING ••-'•• •?? P.C. SOX 1391
Bab CEDAR POINT BLVD. rrrrn .•.u.u NEW SUN. N.C.
w...w u.l - r • .N' SWANSOOR0. M.C.
I.1•N• •.I M•
IWIr N Irr1 I•N .109 NO. 11
!
ti
1=,, II7S la+Jn1 -? G,4
COUNTY NEIGHBORHOODS
See other side for numbers 1.21
r
(Oriental Neighborhoods) and 3; ? I
59 (Minnesott Beach).,.
\ <,J wildlife ... ,rf
-22 Creek
(,L 1e s V1r oint
-? , Y ICY Io?Tr. PA M L I C O 1 5 ThdianEsttat s
•v-, innesott Estates 44, OUNTY N? 2 Creek
I t,? 27 Neuse 'Inds
29
E - * -?c-- Pelican Point
e.r 01, a°c.?..., ?.._ -Broad View
,;at
?•Rn/r s ="w.,. I 31 Broad Crook Village
'
o°° ;IaY '? ti.? ?'' • v `. ?' 32 Up the Creek
lJ C' 1 .:y J gnYbore 11 .; tin ? .,, ..h, r
SS I ?? ° ?' rI 4 - °=t? 33 Forestshore Estates
13 Il o, ,,, SZ . ' °•, `\ 34 Cartwright
I ' s s .,. t = - ??
35 Fork Point
r
36 a -?a ?`. Waters
Edge
?._.......?..__..___ X
` M
37 Browns Creek
38 Spi r ee
vwd Potosin 39 Headwaters
JpV?
40 Sunset Shores
41 Silver
%,,, rr..,t, M •.? =u. Acres
1 ?? UI) a 42 Paradise Shores
• »rs?, 43 Mason Bay
W?
PAHL ICO "?- 3 ?? •r.,. 44 Bay Shore Estates
306 QCOHHUKITY ???,a° ,r "?,? `' .• um e
45 Moore Creek
COLLEGE ,
...... .0 78 + 46 Dogwood Landing
55 , 47 Bayview Estates
i' k 48 Ball Creek
t ?y4.,A :,u '• 1005 ''r 1 /? r?^u+a. ` `?y t00: {I '=+s j
49 Brandy Bay
s Are?,bee 50 Osprey Point
51 Creek Point
?Y 52 Bell Point
53 Say Breeze
,,ter ,z° •r s 54 Baird's Shores
55 Saltayre
56 Cabin Creek
• ??"??° ?; 57 Dawson Bluff
„o• 58 Oriental plantation
Office Use Only:
USACE Action ID No.
(If any partici
1. Processing
not applicable to
No.%l
enter "NWA00li?ble
Form Version May 2002

APR 14 2003
1. Check all of the approval(s) requested for this project: , l; NITM
® Section 404 Permit [-I *t&ii;`?N PUWW r Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
[] 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: GC3362 GC3365 GC3351
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: 10
II. Applicant Information
1. ' Owner/Applicant Information
Name: Darrell Henry
Mailing Address: 32640 Chestnut Ridge RD.
North Ridgeville
Ohio 44039
Telephone Number: 440 327 6543 Fax Number: same
E-mail Address:
2. Agent/Consultant I nformation (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
III. Project Information
8.
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires i nformation t o b e s ubmitted on sheets no t arger than 11 b y 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Private Pesidence " Henry amil?z "
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): J05-6-8
4. Location
County: Pamlico Nearest Town: Merrit
Subdivision name (include phase/lot number): Mason say lot- 8
Directions to site (include road numbers, landmarks, etc.): NCSR1324 4.25 mi1PG nff NC'S5
lot next to first major bridge headed toward `Flnranrc (NC'RS1'424aka
Florence Whortonville rd)
5. Site coordinates, if available (UTM or Lat/Long):
(Note- If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): 3.93
7. Nearest body of water (stream/river/sound/ocean/lake): Mason Creek on Bay River
River Basin: Neuse
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/mps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Wooded lot next water with several fingers of
not completely draining areas protruding towards the middle of the
property across drive area.
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: To clear
trees as needed improve driveway, excavate for house. grade small areas,
limited fill where needed construction of private home with boat dcckaae= -
(eamt) backhce bobcat ronrrPtP trucks and pump n,Gah1P ln_q t-r„nk_
11. Explain the purpose of the proposed work: private home with improved driveway
and boat dockage
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
Septic installed 1997 record 1552 permit 3030
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
lAR(111n02.91 limPri time r^nnc?rnnno during home constuction
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
1. Provide a written description of the proposed impacts: Possible silt during con€truction
and water disturbance during dockage piling installation
2. Individually list wetland impacts below:
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
construction _ .0 es 140 bay salt marsh
11 It
excavati n
grading 0 " 130-140
fill -in „ 140 low areas

* List each impact separately and identify temporary impacts. impacts inciuae, out are not urrutea to. tncunanaxu "um unx, v4uiuy„ 1,,,,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
ss 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at htty://www.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: 1 - 33 acrP
Total area of wetland impact proposed: -10
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
lease specify)

* List each impact separately ana taennry temporary impacts. tuipm Lb unauuc, „u, W. ........... .....?. - ------ -- .. I
darns (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.tonozone.com.
www.mamuest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 130
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Name of Waterbo
(if applicable) dy Type of Waterbody
(lake' pond' estuary' sound,
bay, ocean, etc.
construction Mason Creek Bay River

List each impact separately and identify temporary impacts. impacts include, but are not limited to: nu, excavanon, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
silt- fPncP Straw and lanrdgr•apincl
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreagetlinear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at htty://h2o.enr.state.nc.us/wrp/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. T he applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify, )?
Yes ? No ® If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
^ra z and Raincuatcr hn1r1;nn i-aQkr, to reuse dS needed for land.rping
XII. Sewage Disposal (required by DWQ)
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.
septic installed 1997
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No Fx]
Is this an after-the-fact permit application?
- Yes ? No Q
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
App can Ag is Sign / ' J Date
(Agent's signature is valid only iatu authorization letter from the applicant is provided.)
Page 12 of 12
S 56' 02' 22' E 20. 01' • A•
S 38' 59' 52' E 29. 07' \ 9
S 29' 52' 46' E 5 1. 64''?j • H1
S 73'01' 22'W 25.95' \ m
y
S 73.08' 091E 87.06'
S 44' 15' S3' E 72.55' ?S 15' 17' 39' E \ N
M. H. W. 26. 6 1'/
MASON CREEK
i
S 42'21'50'E 59.55' MARSH LINE ro
w
S 53.27' 101E 17.67
"75' A.E.C. I a
S 16' 20' 39' E 73.12'
/
S 21'27'26'E 72.68' \"4 WETLANDS LINE
S 5 1' 23' 47' E 23.59'
l V \
5 5 1' 23' 47' E 9.48'. 18. 04' UL \ I
s-? - o
3.93 ACRES \ \
0
2 3? ds \ UL
U L
1 UL
V
S 3i, N.II.F
7 a :?
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N.C. GRID AS PER
BK. 178, PG. 197 ^-
,
100 G loo 200 300
iTTiIIT[ .__..--•--- -
S 56.02' 22' E 20.01' • A• O
S 38' 59' 52' E 29. 07' \ 9
S 29052'46'E 51.64-
S H'
73' O 1' 22'W 25. 95' \
S 73' 08' 09' E 87.06'
?A
S 44' I S' S3' E 72.55' M. H. W. 26! 6 1% 3-' E
MASON CREEK
S 42' 2 I' S0' E 59. 55' MARSH LINE
S 53'27' 10'E 17.67, \
m75' A.E.C.
S 1 6' 20' 39' E 73. 12'
S 21'27'26'E 72.68' WETLANDS LINE
S 51'23'47'E 23.59'
S 5 I' 23' 47' E 9.48' \ WL \ I
-A. B^ 18. 04' ?
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--? N. C. GRID AS PER
BK 178 P
100 0 100 200 300
.T. r
_..----- -
NOTE: ??
This drawing was created for preliminary planning and Is not a - --- 1
complete description of the lot shown. It Is not for subdivision
description. It la notfornoordation. conveyance or final design. See
subdivision plat and restrictive covenants for further description.
Mason Bay
LOT #8
Pamlico County, NC
Legend
Marsh
;P
PAMLICO COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
CERTIFICATE OF COMPLETION
'( ) OPERATION PERMIT
ISSUED Tb: ,ON PERMIT# 03CJ
ADDRESS:- RECORD # • 15 5 2
MAP # JOS-6-8
PHONE: SR # OFF 1324
LOCATION: S/D ON 1324 BEFORE FLORENCE INTERSECTION
MASON BAY ESTATES: LOT # 8
WATER SUPPLY:
PUBLIC
( ) PRIVATE: feet from closest point of septic system
!INSTALLER: Jivgr?{?rr al ? n i CODE #
APPROVAL: This.system bas been inspected by'the signing Sanitarian and
has been APPROVED as shown on the:
( ) PLOT PLAN
,( ) FINAL PLOT
( ) ELECTRICAL INSPECTIONS APPROVAL RECEIVED: SEE ATTACHMENT
OPERATIONAL PERM IT;:RESTRICTIONS AND"STIPULATIONS:
( ) This systek will be inspected time(s) a year
( )WATER;CONSERVATION DEVICES OR METHODS
Comments'-
( ) ADDITIONAL:

***********t***«:«*«*«««««««««!FINAL PLOT «****************************
i'
J

ASANITARIAN PVROVAL DATE.
NOTE: THE OWNER OR CONTROLLER OF AjP•R ERTY IS RESPONSIBLE FOR THE
MAINTENANCE OF A GROUND ABSORPTION SEPTIC SYSTEM IN A MANNER
WHICH WILL NOT EMIT EFFLUENT OR CONTAMINATION TO GROUND SURFACE
OR SURFACE WATERS. VIOLATIONS OF THIS LAW ARE PUNISHABLE AS A
MISDEMEANOR UNDER G.S.13OA-23&25. (P.ef.1961)
Nos" call.
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FINAL FLAT OF.
MASON BAY
WEYERHAEUSER . PAW.ICO NUMBER 39
NUMBER It T P.. FAMLICO COUNTY. M.C.
SCALE. 1• • IOW DATE: SEPT. 17. 1969
OMMEN9
WEYERHAEUSER REAL ESTATE COWANY
P.D. sox 1391
NEW ISBN. N.C.
aYY1 .? FI
IwIM M /wl IM a0i MI
rl M
COUNTY NEIGHBORHOODS
See other side for numbers 1-21 •'
(Oriental Neighborhoods) and
59 {Minnesott Beach). ?.,. ?•* :,,,°_
V Wife
."ot*• ?. ?;,q.,. H ?,?? ,_= 22 Hid a reek
_?•? -_ _- ! ?? -? •? ?? I r- `?' R,[ y 1 J•• h Dint
ton ay
-? _ t? tqWTr. PA M L I C Q T?+dia, Estates
COUNTY 25 innesott Estates
NC ,
reek
06 _
10 27 0 N inds
,
29 _ NY tt: E st sr c c ?-=t _ J0"''^.« j Pelican Point
---et t u QBXoa View
s
° I 31 Broad Creek Vill g
e
''?, ?if??. ,:'a J S"r.:Ar1, {j' t2U= \°c? , .06 Ne•'r.. ?ti' 32 UP a
p the Creek
?? ? ? .`' :. •?, a 33
r ;! •.?,,,,,? N, .,=t :? Forestshors Est
,a c , ?`• , s°'
SS j??'o / =fde^j o ltl - q"
s r • ''? 34 Cartwright aces
`/ d+c s`s •rD, ' 1 '''lu1 52 4g yfy ` •r `? 3 g
?.•_? 47,& P, 30 Fork Point
Waters Edge
,,1- g L ..... -_ Y _ _."`,a _ 3 • _ u?? - - N 37 Browns Creek
38 Spicers Creek
ti?0 lsgx
39 Headwaters
40 Sunset Shores
re
1 r i `?? J •? Jug 41 Silver Acres
,3: 4
42 Paradise Shores
• 43 Mason Bay
_ b N PAHL ICO ?'>>' J .?9 ..??•:rY.w. 44 B
306 OCOHHURITY , o, t .V Bay Shore Estates
. _•__, _ ? _ ,. 45 Moore Creek
COLLEGE t• ' ice
.e tTm 30 79 ' 46 Dogwood
Landing
I "c . ?.. _ .. - 47 Bayview Estates
48 Ball Creek
r??'4?,• 'su 1005 ?'C. /? t?Ml. ^= ts)D: {t , . 49 Brandy Bay
-? 50 Osprey Point
c. $ prop°be• ?c° i?+o `DDS I ? Xy?
51 Creek Point
~ 52 Bell P
oint
t>o, 53 Bay Breeze
%r'- , ° •r ?,? 2 54 Baird's Shores
tic, w 55 Saltayre
56 Cabin Creek
x ot0o . 57 Dawson Bluff
58 Oriental PI
antation
Office Use Only: Form Version May 2002
X30455
USACE Action ID No. DWQ No. , , .•-?.. , .,?
(If any particular item is not applicable to this project, please eater "No `Applibi la':` r',"NIAOj
I. Processing APR 14 2003
1. - Check all of the approval(s) requested for this project: L(Te?
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
? 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: GC3362 GC3365 GC3351
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here:
II. Applicant Information
1. Owner/Applicant Information
Name: Darrell Henrv
Mailing Address: 32640 Chestnut Ridge -RD'-
North Ridgeville
Ohio 44039
Telephone Number: 44o 327 6543 Fax Number: Ga m
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE r equires i nformation t o b e s ubmitted o n s heets n o t arger t han 11 b y 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Private Residence " Henry Family " -
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): J05-6-8
4. Location
County: Pamlico Nearest Town: Merrit-
Subdivision name (include phase/lot number): Mason Bay lot' 8
Directions to site (include road numbers, landmarks, etc.): NCSR1324 4.25 miles nff Nr`55
lot next to first major bridge headed tnward --T1nranra (NCRS1324aka
Florence Whortonville rd)
5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): 3.93
7. Nearest body of water (stream/river/sound/ocean/lake): Mason Creek on Bay River
8
River Basin: Neuse
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Wooded lot next water with several fingers of
not completely draining areas protruding towards the middle of the
property across drive area.
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: To clear
_trees as needed improve driveway, excavate for house. grade small areas,
limited fill where needed, construction of private home with boat dockaae-
(eamt) backhoe bobcat ron rei-e trucks, and pump L=nGCah1P Ing triir•k_
11. Explain the purpose of the proposed work: private home with improved driveway
and boat dockage
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
Septic installed 1997 record 1552 permit 3030
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
]()T4111IIo O?C)i 'l ^lC1 llmarl tlma rr,n Qf-YaMCQ during home constuction
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
1. Provide a written description of the proposed impacts: possible silt during construction
and water disturbance during dockage pilina inst-11at•ion
2. Individually list wetland impacts below:
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
construction 0 yes 140 Bay Salt Marsh
mech clearin 0 11
0 11
radin 0 130-140
fill -10 140 low areas
fil
* List each impact separately and identify temporary impacts. Impacts include, but are not llnuted to: mechanized cleanng, grading, I ,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at httv://www.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: 1.33 acres
Total area of wetland impact proposed: 10
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before impact Perennial or
Intermittent?
lease specify)

_+__?_ i..• _ . 1:«. -A ?... ....1 et one -nrintPd fin-rail
* List each impact separately and identity temporary impacts. impacts Include, but air noL 111 ,L. •°-- .. r
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapquest.com, etc.).
I 130
Cumulative impacts (linear distance in feet) to all streams on site:
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, cean, etc.
construction Mason Creek Bay River

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: nu, excavation, areagmg,
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative; lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
silt fence straw and landscaping
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater' wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USACE = In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/stniigide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http•//h2o.enr.state.nc.us/wrp/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. T he applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ? If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If'buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
* Zone I extends out 30 feet perpendicular from near bank of channel; Gone l extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI.
Mi.
Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Gray and Rainwater holding tanks to -=-reuse as needed for lancisrap ing
Sewage Disposal (required by DWQ)
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.
septic installed 1997
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No ?x
Is this an after-the-fact permit application?
- Yes ? No ?
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

icant/Agent's Signat Date
(Agent's signature is valid only if authorization letter from the applicant is provided.)
Page 12 of 12
S 56' 02' 22' E 20.01' • A' O
S 38' S9' S2' E 29.07' \ 9
• H"
S 29' S2' 46' E 51.64'
N
S 73.01' 22' W 25.95'
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S 73' O8' 09' E 87.06-
,--& o!
M H W. ?S 26. 6 6 1 {1 17' 39' E \ N
V S 44' 15' S3" E 72.55'
. . '
MASON CREEK 1-1 11-1
S 42.21' S0' E 59.55' MARSH LINE ro
S 53'27'I0'E 17.67
/ w
75' A.E.C. p
S 16' 20' 39' E 73.12'
S 21'Z7'26'E 72.68' WETLANDS LINE f
S 51'23' 47'E 23.59'
S 5 1. 23' 47' E 9. 48' ?4 f \VWL \ 1
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_7 N. C• GRID AS PER -7 °/
-4-1 9K• i 78 J PG. 197
100 r r (i 100 200 300

S 56' 02' 22' E 20, 0I' • A•
S 38' 59' 52' E 29. 0 \
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S 29
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S 73' O 1' 22' W 25.95'
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S 44-15-53-E &
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MASON CREEK /
i
S 42' 21' 50' E 59.55' MARSH LINE
S 53'27' 10'E 17.67

S 16' 20' 39' E 73
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.
S 2I'27'26'E 72.68' WETLANDS LINE
S 5 1' 23' 47" E 23. 59'
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1 BK. 178, PG. I97
NOTE:
This drawing was created for preliminary planning and Is not a
complete description of the lot shown. It Is not for subdivision
description. It Is not forteoordation, conveyance or final design. See
subdivision plat and restrictive covenants for further description.
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Mason Bay
LOT #8
Pamlico County, NC
Legend
Marsh

PAMLICO COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
CERTIFICATE OF COMPLETION
'( ) OPERATION PERMIT
t:z 3,
' '0N PERMIT4;
ISSUED T0: - rlr%' -
ADDRESS: RECORD # 1552
MAP # JOS-6-8
PHONE: SR # OFF 1324
LOCATION: S/D ON 1324 BEFORE FLORENCE INTERSECTION
MASON BAY ESTATES: LOT # 8
WATER SUPPLY:
PUBLIC
( ) PRIVATE: feet from closest point of septic system
"INSTALLER: Zu- r? . ? 2,Z?:6_ L CODE # rP
APPROVAL: This.system has been inspected by'the signing Sanitarian and
has been APPROVED as shown on the:
( ) PLOT PLAN
FINAL PLOT
( ) ELECTRICAL INSPECTIONS APPROVAL RECEIVED: SEE ATTACHMENT
OPERATIONAL PERMIT,/RESTRICTIONS AND"STIPULATIONS:
( ) This system will be inspe.c^ted time(s) a year
( ) 'WATER; CONSERVATION DEVICES OR 'METHODS
Comments- '
( ) ADDITIONAL-
*xxxxxtxtxxxkxxxxxxxxxxtxxxxx+t'FINAL PLOT xxxxxxxxxxxxxxxxxxxxxxxxxxxxx

SANITAI VAL DATE."
NOTE: THE OWNER OR C014TROLLER OF e?iMERTY S RESPONSIBLE FOR THE
MAINTENANCE OF A GROUND ABSORPTION SEPTIC SYSTEM IN A MANNER
WHICH WILL NOT EMIT EFFLUENT OR CONTAMINATION TO GROUND SURFACE
OR SURFACE WATERS. VIOLATIONS OF THIS LAW ARE PUNISHABLE AS A
MISDEMEANOR UNDER G.S.13OA-23&25. (P.ef.1961)

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COUNTY NEIGHBORHOODS
See other side for numbers 1-21
1
(Oriental Neighborhoods) and ;; al I
59 (Minnesott Beach)._• ?'••? =t=
_ \ .? •?,' ??. 1?,• 22 Hi reek
qM` \ ?? ..... .?? .? ?? •? l R M 1 70? ti h ? it trt reek
- - _" _ p?1MLIC0 ? on ay &
-? r?*tc° t°?`r• Ttldian Estates
t1l6 1:xx ?Gr. 5 innesott Estates
,,e I r
COUNTY
A.- ? Crook
----- 06
s : s x== c :r ?oce=r• tle? r` 7 Neuse nds
411 29 Pelican Point
ttu a, clt,) ; u= S} 0 C-
0 Q - t 3._.. , _ ..•..._? ?,.__ - Qeto$d View
A
I? 31 Broad
?, s.'.nltl{t 120 tIM ? 32 Creek Village
•? .• ?' . A f xl R 1+CR p the Creek
c S c '°•rk ;' 'i\' l 04
Baybore (I - b,x„ ?• °? 33 Forestshore
• -? I - =1„ _ _ i • .. 34 C Estates
S 1 j ; ° t,•t s s` .,o+ ?.' ;,'" sz • aA
4t 35 For Point
N,, cg 4T. yP, 6
1 1131 f
Waters - _ -- - - X s .44
° 37 Edge
X10, g Y - " ?? _ _ • a:? 46 Browns Creek
------ - -- 38 Spicers Creek
„y tlgst 610u+G roc0s+n 39 Headwaters
1 e
40 Sunset Shores
rr?? `?+y.a=e ^ tub 41 Silver Acres
e a 42P Paradise
aradis Shores
t. ?"?J'r tJ12 ?,+> "• . ,>:{.,,? 43 Mason Bay
111+ N C PAHL IC0 r-1?•?t1+ 3 '97 =
ay Shore
44 B Estate
.0 306 000HHUtt1Tr co% 45 Moore Creek S
-•---°°- ? - ? ^ COLLEGE , ? ? •. /
- -
Kc 13 30 ?s r ?6 Dogwood Landing
7 7 Bayview Estates
f 48 Ball Creek
?? `¢ : I t, Joos °? t-? `.,, •:' ` ,o? _: , r y i 49 Brandy Say
p5 I 'I:c.
/,reVehee 1cc' a
5 50 Osprey Point
51 Creek Point
?,.+ ay 52 Bell Point
X100 •Ib ?, $
53 Bay Breeze
54 Baird 's Shores
r „p2 tJZr ?`? 55 Saltayre
56 Cabin Creek
+• z .? 57 Dawson Bluff
11x, „?. 58 Oriental plantation
1
Office Use Only: Form Version May 2002
0..
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
rw?f.,' C 'up
I. Processing
1. - Check all of the approval(s) requested for this project:- APR 14 2003
Buffer Ru
lers
® Section 404 Permit ? Ripari =fZtRW
Section 10 Permit Isolatedermitlom DW
? 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: GC3362 GC3365 GC3351
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here:
II. Applicant Information
1. Owner/Applicant Information
Name: Darrell Henry
Mailing Address: 32640 Chestnut Ridge--RD''.
North Ridgeville
Ohio 44039
Telephone Number: 440 327 6543 Fax Number: sa m P
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5of12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site'plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and MRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE r equires i nformation t o b e s ubmitted o n s heets n o t arger t han 11 b y 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
. 1. Name of project: private Residence " Henry Family "
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): J05-6-8
4. Location
County: Pamlico Nearest Town: Merrit
Subdivision name (include phase/lot number): Mason Bay lot' 8
Directions to site (include road numbers, landmarks, etc.): NCSR1324 4.25 miles, aff NC'55
lot next to first major bridge headed toward `!Plnranr-e (NC'RS1324aka
Florence Whortonville rd)
5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): 3.93
7. Nearest body of water (stream/river/sound/ocean/lake): Mason Creek on Bay River
8. River Basin: Neuse
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Wooded lot next water with several fingers of
not completely draining areas protruding towards the middle of the
property across drive area.
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: To clear
trees as needed improve driveway, excavate for house, grade small areas,
limited fill where needed construction of private home with boat dockaae-. -
(eamt) backhoe bobcat rnnrrPtP trunks and p i? imp nGCahla lnn trnak _
11. Explain the purpose of the proposed work: private home with improved driveway
and boat dockage
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
Septic installed 1997 record 1552 permit 3030
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
19soooo2gi limarl t-JM@ rnnctranrw during home constuction
VI. Proposed Impacts to Waters of the United States/Waters of the State
it is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
1. Provide a written description of the proposed impacts: possible silt during construction
and water disturbance during dockage piling insulation
2. Individually list wetland impacts below:
Wetland Impact
Site Number
indicate on ma
Type of Impact" Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
construction 0 yes 140 Bay Salt Marsh
mech clearin 0
0 11 ??
grading 0 130-140
fill -10 140 low areas

* List each impact separately and identify temporary impacts. Impacts include, but are not urmtea to: mechanized clearing, glaulng, .111,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at htro://www.fema.eov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: 1.33 acres
Total area of wetland impact proposed: 0
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)

J_ L... _ • 1:? ...7 ........I,re .+c nnrr o nnlntpd rill-rnn
It List each impact separately and identity temporary impacts. impacts imaudc, uul CLIF IIVI 111--- - w.,. -9V -_ -•r --r.
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.goy. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.tooozone.com.
www.maoauest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 130
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.
construction Mason Creek Bay River

• List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative; lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
silt fence straw and landscaping
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
htti)://h2o.enr.state.nc.us/ncwetlands/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http•//h2o.enr.state.nc.us/wry/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX.
X.
Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. T he applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify, )?
Yes ? No ® If you answered "yes", provide the following information:
Identify the square feet and acreage of impact
mitigation is required calculate the required
multipliers.
to each zone of the riparian buffers. If'buffer
amount of mitigation by applying the buffer
Zone* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
Zone I extends out 30 feet perpendicular from near bank of channel; Gone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 1 l of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Gray and Rainwater holding tanks to :.ireuse as needed for landsra ;ng
XII. Sewage Disposal (required by DWQ)
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.
septic installed 1997
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No 0
Is this an after-the-fact permit application?
- Yes ? No x?
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

Applfcfnt/Agent's Signature / Date
(Agent's signature is valid only if an autho ati letter from the applicant is provided.)
Page 12 of 12
S 56' 02' 22' E 20. 01' • p• O
S 38' S9' S2' E 29. 07' \ 9
S 29-52-46-E 51.64' "1
S 73' O 1' 22"W 25. 95'-" V S 73' 08' 09' E 87. 06' --& ""?
S 44' 15' S3' E 72.55' M H W S 26.6 61 I1 17' 3?' E \
. . , '/
MASON CREEK
i
S 42' 2 1' 50'E 59. 55' MARSH LINE
S 53'27' 10'E 17. \
75' A.E.C. I
S 16' 20' 39" E 73. 12' \2?
S 21'27'26'E 72.68' WETLANDS LINE
S 51'23' 47'E 23.59'
S 5 1' 23' 47" E 9.48'-- { \ WL \
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BK. 178, PG. 197
100 0 100 200 300

S 56' 02' 22' E 20.01' • A'
S 38.59' 52' E 29. 07' \ 9
S 29' 52' 46' E 5 I. 64'' 7 • H.
N
S 73' 01' 22' W 25. 95? o,
S 73' 08' 09" E 87.06- A o:
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S 44' 15' 53" E 72.55' M.H.W. ?S 26.61*
N
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i
S 42'21' 50' E 59. 55' MARSH LINE ro
/ w
e
S 53'27'10'E 17.67 /
` X75' A.E.C. ( A
S 16' 20' 39' E 73. 12'
S 2 1' 27' 26' E 72.68' WETLANDS LINE
S 51'23' 47'E 23.59-
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S 5 1' 23' 4T' E 9. 48'x,_ \ WL I
-ew Aa- 18.04' i i
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1 BK. 178, PG. 197
100 0 loo 200 300
NOTE: LIT ff 11l11 _ _ --`--- --,
This drawing was created for preliminary planning and is not a I
complete description of the lot shown. It Is not for subdivision
description. It is not for recordation, conveyance or final design. See
subdivision plat and restrictive covenants for further description.
Mason Bay
LOT #8
Pamlico County, NC
Legend
.?L Marsh
PAMLICO COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
CERTIFICATE OF COMPLETION
"( ) OPERATION PERMIT
ISSUED TO: -'ON PERMIT# 30?
ADDRESS: RECORD # ' 1552
MAP # J05-6-8
PHONE: SR # OFF 1324
LOCATION: S/D ON 1324 BEFORE FLORENCE INTERSECTION
MASON BAY ESTATES: LOT # 8
WATER SUPPLY:
4) PUBLIC
( ) PRIVATE: feet from closest point of septic system
'INSTALLER: CODE #_
APPROVAL: This.system has been inspected by*the signing Sanitarian and
has been APPROVED as shown on the:
( ) PLOT PLAN
FINAL PLOT
( ) ELECTRICAL INSPECTIONS APPROVAL RECEIVED: SEE ATTACHMENT
OPERATIONAL PERM IT;%RESTRICTIONS AND''STIPULATIONS:
( ) This system will be inspected time(s) a year
( )'WATER; CONSERVATION DEVICES OR METHODS
Comments': '
( ) ADDITIONAL:
t««*««+t*:*«:«««««««««««««««««« FINAL PLOT ««««««*««««r?«««**««t««««t«rct

SANITARIAN,: IROVAL DATE
NOTE: THE OWNER OR C014TROLLER OF e??UPERTY S RESPONSIBLE FOR THE
MAINTENANCE OF A GROUND ABSORPTION SEPTIC SYSTEM IN A MANNER
WHICH WILL NOT EMIT EFFLUENT OR CONTAMINATION TO GROUND SURFACE
OR SURFACE WATERS. VIOLATIONS OF THIS LAW ARE PUNISHABLE AS A
MISDEMEANOR UNDER G.S.13OA-23&25. (Ref.1961)
6
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iuuTUn [tort . (I
V.-...r.«•rrw «wr« SCALES 1' • 100'. DATE: SEPT. 27, ISSt
w•w• Nww,N '
nww. OWNERS
WRY[TEO STt •w n. WEYERHAEUSER REAL ESTATE COWANY
• r•• .•• ALAN SELL SURKYINi •r"'••«.•-•,•w• ?.O. BOX 1151
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See other side for numbers 1.21 !
(Oriental Neighborhoods) and
59 (Minnesott Beach
),s• ?.•? :,,,
tr tellre j .`R rr? _
22 Hid reek
._ ..,. W,
f- oint
ton ay &
PA M L I C O Indian Estates
=,ze ! I:i: a 25 innesott Estates
COUNTY NC Creek
0 4 27 Neu
i.._.. ?_.. , .? •°?a?s•', •i Se Inds
29 Pelican Point
etr of ) ( gut T} e c c 7_.. ,. -.•••-.nt;,-,..»_ I p??
==c, r 0 ?• -- 8r_oad vie
4 h. \
31 road Creek Vi
;YDS 1. 32 U Ilage
J I H :1 ti, ?,•?• p the Creek
?• ?"?? 1 t bJ n oa ,r 4,•re a+ '\ 33 Fore$tShors
C. t •j;? to B•Ybore ll ^ f L tzt7 • rt
SS `, r - • 'K 11- 11 1:11
r • ''. 34 Cartw Estates
ght
t s S ,tp° °?,?? sz 4a • ,, ?,,•?
e ri
ail' ,=?z S F * ,7u J per, ' .? 47* y?o 'Fi 35 Waters ForPoint
.
1tSe-? ?g__ X 36 Edge
-
........... _..._._,..._ Y r
?.,, -f s .,?? _ _ `, _ _ s • ,„? ? ? 37 Browns Creek
-- 38 Spicers Creek
I L ,,,_ 6,ot•e•«..;^ ! ,,y ?.? - ,•?, - 39 Headwaters
40 Sunset Shores
?`° S ,?,•,« - 41 Silver Acres
42 Paradise Shores
r''? k' „n .? i • ,u:,, 4113 Mason Bay
N C PAHL ICO
44
B$
re Estates
306 0COHHUttITY
45 Moore
COLLEGE Y ShCreek
. _.___._..- ? - ?? ^ c? ? ? Iu0 36 79? rr•
oo,
6 Dogwood Landing andin9
ss` _ ?.. _ .'. 7 Bayview Estates
48 Ball Creek
?'r ! r 4ti, Ioni {l ?',tr I
4 -? loQS 'r ^t. -• 49 Brandy Bay
1 c 5 Aro9o?,eo ,cc r? i??S 50 Ospiey Point
a 51 Creek Point
52 Bell P
•? ?. ? y - oint
53 %, ?. IXK t o??eM,: aY Breeze
Z, 54 Baird's Shores
55 Saitayre
56 Cabin Creek
• ?•"? ??'.• 57 Dawson Bluff
M 58 Oriental Plantation
m•.
y
Office Use Only: Form Version May 2002
USACE Action ID No. DWQ Nojdr-1 .? e i a,
(If any particular item is not applicable to this project, please enfdf Mt A? Olkibl W PN/ ".
1. Processing
APR 14 2003
1. Check all of the approval(s) requested for this project: [QUALITY 'A xr?
© Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: GC3362 GC3365 GC3351
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: 0
II. Applicant Information
1. Owner/Applicant Information
Name: Darrell Henry
Mailing Address' 32640 Chestnut Ridge RD. North Ridgeville Ohio 44039
Telephone Number: 440 . 3276543 Fax Number: same
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires i nformation to b e submitted on sheets n o t arger than 11 b y 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Private Residence " Henry amily "
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): J05-6-8
4. Location
County: Pamlico Nearest Town: Merrit
Subdivision name (include phase/lot number): Mason say lot-8
Directions to site (include road numbers, landmarks, etc.): NCSR1324 4.25 miles, off NC55
lot next to first major bridge headed toward 7T1nrAnrn (NORS1324aka
Florence Whortonville rd)
5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): 3.93
7. Nearest body of water (stream/river/sound/ocean/lake): Mason creek on Bay River
8. River Basin: Neuse
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/mays/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Wooded lot next water with several fingers of
not completely draining areas protruding towards the middle of the
property across drive area.
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: To clear
trees as needed improve driveway, excavate for house, grade small areas.
limited fill where needed, construction of private home with boat dockaggl? -
eamt) backhoe bobcat on r-tP trucks and pump lnq
11. Explain the purpose of the proposed work: private home with improved driveway
and boat dockage
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
Septic installed 1997 record 1552 permit 3030
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
19Rnnnn291 rT 1-?Cil limPrl time rnnctr?nr•c during home constuction
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial)-must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
1. Provide a written description of the proposed impacts: ?oGGib1P Silt during onst-r tction
and water disturbance during dockage piling installation
2. Individually list wetland impacts below:
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
construction 0 es 140 bay salt marsh
MCH',
`' clearin
0 111
fill .1 'd
If
140.
low area
excavation 0 140
grading 0 - -in
* List each impact separately and identify temporary impacts. impacts inciuae, but are not umtted to: mechanized clearing, grading, nu,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
«+ 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at htty://www.fema.gov
*'• List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: 1- 33 acres
Total area of wetland impact proposed: -10
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream .
Before Impact Perennial or
Intermittent?
lease specify)

* List each impact separately and identify temporary impacts. impacts include, out are not umtteu w: uulvulw lulu aawcial,cu uN-10F,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usys.gm. Several intcmet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 130
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.
construction Mason Creek Bay River

* List each impact separately and identify temporary impacts. impacts mciude, but are not umttea to: nu, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
silt fence straw and landsrap ing
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
httv://h2o.enr.state.ne.us/ncwetlands/stnngide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at htty://h2o.enr.state.nc.us/wrp/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ? No ?x
If yes, does the project require preparation of an environmental document pursuant-to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes El No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. T he applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify, )?
Yes ? No E If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
• Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Gray-rainwater holding tanks to be used for landscaping needs
XII. Sewage Disposal (required by DWQ)
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.
Septic installed 1997
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No ?X
Is this an after-the-fact permit application?
- Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
Page 12 of 12
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
a
S 56' 02' 22' E 20. 01' • A• /
S 38'59' 52'E 29.07' \ 9
S 29-52-46-E 51.64' • Fi'
S 73'01' 22"W 25.95' V
S 73' 08' 09' E 87. 06`&, ??
S 44. 15' 53' E 72. 55' M S I 1 7'39'E \
. H. W . 26. 6 6 1 1 /
MASON CREEK
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S 42' 2 I' S0' E 59. 55' MARSH LINE
S 53'27'10'E 17.67 \
?75' AE.C.
S 16' 20' 39' E 73. 12' \?4
S 2 1' 27' 26" E 72.68' WETLANDS LINE
S 51' 23' 47"E 23. 59'?
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NOTE:
This drawing was created for preliminary planning and is not a
complete description of the lot shown. It is not for subdivision
description. We not for recordation, conveyance or final design. See
subdivision plat and restrictive covenants for further description.
100 U 100 200 300
- F1
Mason Bay
LOT #8
Pamlico County, NC
Legend
?. Marsh
h i
PAMLICO COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION:
ISSUED T0: <ON PERMIT# 03C?
RECORD # 1552
ADDRESS: J2 ' r
MAP # J05-6-8
PHONE: SR # OFF 1324
LOCATION: SID ON 1324 BEFORE FLORENCE INTERSECTION
MASON BAY ESTATES: LOT # 8
WATER SUPPLY:
G' ) PUBLIC
( ) PRIVATE: feet from closest point of septic system
'INSTALLER: err rr : j,jja CODE # 1 r?
APPROVAL: This.system has been inspected by the signing Sanitarian and
has been APPROVED as shown on the:
( ) PLOT PLAN
FINAL PLOT
( ) ELECTRICAL INSPECTIONS APPROVAL RECEIVED: SEE ATTACHMENT
OPERATIONAL PERMIT/'RESTRICTIONS AND'STIPULATIONS:
( ) This system will be inspected time(s) a year
( )'WATER-CONSERVATION DEVICES OR METHODS
Comments'-
( ) ADDITIONAL:
:**,?*,?at*e:t**x«t?+txttx:xt:;FINAL PLOT axs??ttttt*,ttt***tt:*xxtxt*

SANITARIAN. AL DATE
-UP
NOTE: THE OWNER OR CONTROLLER RESPONSIBLE FOR THE
MAINTENANCE OF A GROUND ABSORPTION SEPTIC SYSTEM IN A MANNER
WHICH WILL NOT EMIT EFFLUENT OR CONTAMINATION TO GROUND SURFACE
OR SURFACE WATERS. VIOLATIONS OF THIS LAW ARE PUNISHABLE AS A
MISDEMEANOR UNDER G.S.13OA-23&25. (Ref.1961)
' CERTIFICATE OF COMPLETION
OPERATION PERMIT
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COUNTY NEIGHBORHOODS
See other side for numbers 1-21
(Oriental Neighborhoods) and
59 (Minnesota Be
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j Y ltitti
1 t
,A to COW'- MLICO
?,,.???^ ,2z• 22 HQ!' -reek
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C Thdian Estates
ti COUNTY 1222 ,? ?tr p? "!?., yt 2innesott Estates
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7 Neuse
inds
29 Pelican Point
8.1 Cit, Kc J!
Q SMad View
f_
31 32 Broad
the Creek Village
J` P Creek
"•r `\ •? ` 21
fYb,to 04 - ,21, 21212 i ` • . t, tt 0-1 33 t r tJ`' . 34 C restshore
` Estates
?
v
T ,s= 12.A ss

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09st vwd faC00.
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' k-ttt Start

PAML Ito
306 000MMUItITY
_.___..... _ ` ., _ COLLEGE

?-/ I s
y
??? 1123 415A
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04
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1222 M e_ b
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D 30 79 , ?. .
n
35 Fork Point
36 Waters Edge
37 Browns Creek
38 SPicers Creek
39 Headwaters
40 Sunset Shores
41 Silver Acres
42 Paradise Shores
43 Mason Bay
V? 44 Bay Shore Estates
45 Moore Creek
i 46 Dogwood Landing
47 Bayview Estates
48 Ball Creek
49 Brandy Bay
50 Osprey point
51 Creek Point
52 Bell Point
53 Bay Breeze
54 Baird's Shores
55 Saltayre
56 Cabin Creek
57 Dawson Bluff
58 Oriental plantation

Office Use Only:
USACE Action ID No.
(If any partici
1. Processing
DWQ No.
is not applicable to this project, please enter
Form Version May 2002
04
APR 14 2003
1. - Check all of the approval(s) requested for this project: _ A,,-: ? ? 1? t ;1 , o
® Section 404 Permit ? Rip ittn tO' Ueegh-edn 99tYer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
Q 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: GC3362 GC3365 GC3351
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here:
H. Applicant Information
1. Owner/Applicant Information
Name: Darrell Henry
Mailing Address: 32640 Chestnut Ridge RD. North Ridgeville Ohio 44039
Telephone Number: 440 327 6543 Fax Number: same
E-mail Address:
2. Agent/Consultant I nfonnation (A signed and dated copy o f the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundariei outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE r equires i nformation t o b e s ubmitted o n s heets n o t arger t han I I b y 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Private Residence " Henry am;ly
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): J05-6-8
4. Location
County: Pamlico Nearest Town: Merr;r
Subdivision name (include phase/lot number): Mason Bay lot' 8
Directions to site (include road numbers, landmarks, etc.): NCSR1324 4.29 m;1aG nff Nc55
lot next to first major bridge headed toward -'_T1nrAnrP (NCRS1324aka
Florence Whortonville rd)
5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): 3.93
7. Nearest body of water (stream/river/sound/ocean/lake): Mason creek on Bay River
8. River Basin: Neuse
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httv://h2o.enr.state.nc.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Wooded lot next water with several fingers of
not completely draining areas protruding towards the middle of the
property across drive area.
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: To clear
trees as needed.improve driveway, excavate for house. -grade small areas,
limited fill where needed, construction of private home with boat dockage-?-
(eamt) backhoe bobcat cnnrr,-te trucks, and p limp imp l ossAh1P ing tr„rk_
11. Explain the purpose of the proposed work: private home with improved driveway
and boat dockage
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
Septic installed 1997 record 1552 permit 3030
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
1ARnn002C31=r3r'1-A51 1;mar1 Imo r,nQCA-ganro during home constuction
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
1. Provide a written description of the proposed impacts: Possible silt during constrution
and water disturbance during dockage piling installation
2. Individually list wetland impacts below:
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
construction ..0 VeN9 140
mech clearin 0 11
excav
grading 0 130- 140
fill .10 140 low a

* List each impact separately and identify temporary impacts. impacts include, but are not umtted to: mechanized cieanng, grading, nu,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at htto://www.fema.aov.
*'* List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: 1- 33 acres
Total area of wetland impact proposed: -10
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)

* List each impact separately and identify temporary impacts. impacts incluae, out are not nmheu w: cu,vcus and assuclaWd uY-aar,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net losstgain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usas.aov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.tooozone.com,
www.mapguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 130
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres
Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.
construction Mason Creek Bay River

* List each impact separately and identify temporary impacts. impacts include, but are not litmtea to: tui, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
silt fence straw and landscaping
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the -NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
htty://h2o.enr.state.nc.us/ncwetlands/strmuide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreagellinear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wrt)/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. T he applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify, )?
Yes ? No 0 If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
s uare feet Multiplier Required
Mitigation
1 3
2 1.5
Total
• Zone 1 extends out 30 feet perpendicular from near bank of channel; "Gone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
M. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
rray and Raini a1-cr holding tanks to reuse ;4sm-piP[l fnr lands-raping
MI. Sewage Disposal (required by DWQ)
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.
sep ti i n stall tnd 1()97
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No Q
Is this an after-the-fact permit application?
Yes ? No ?x
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
pplicant/Agent's S gnature Date
(Agent's signature is valid only if an a rization letter from the applicant is provided.)
Page 12 of 12
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PAMLICO COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
CERTIFICATE OF COMPLETION
'( ) OPERATION PERMIT
ISSUED T0: _ ON PERMIT#
ADDRESS: 1" r RECORD # 1552
MAP # JOS-6-8
PHONE: SF. # OFF 1324
LOCATION: S/D ON 1324 BEFORE FLORENCE INTERSECTION
MASON BAY ESTATES: LOT # 8
WATER SUPPLY:
G.) PUBLIC
( ) PRIVATE: feet from closest point of septic system
'INSTALLER:?rm,,?r CODE # I_
APPROVAL: This.system has been inspected by the signing Sanitarian and
has been APPROVED as shown on the:
( ) PLOT PLAN
(: ) FINAL PLOT
(. ) ELECTRICAL INSPECTIONS APPROVAL RECEIVED: SEE ATTACHMENT
OPERATIONAL PERM IT.,,RESTRICTIONS AND"STIPULATIONS:
( ) This system will be inspected time(s) a year
( )'WATER-CONSERVATION DEVICES OR-METHODS
Comments'-
ADDITIONAL:

******************************i FINAL PLOT * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

SANITARIAN AL DATE.
NOTE: THE _.._.___ OR CONTROLLER RESPONSIBLE FOR THE
MAINTENANCE OF A GROU14D ABSORPTION SEPTIC SYSTEM IN A MANNER
WHICH WILL NOT EMIT EFFLUENT OR CONTAMINATION TO GROUND SURFACE
OR SURFACE WATERS. VIOLATIONS OF THIS LAW ARE PUNISHABLE AS A
MISDEMEANOR UNDER G.S.13OA-23&25. (Ref.1961)

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... ........: .
Office Use Only: I11` Form Version May 2002
j,_l'? e.
USACE Action ID No. DWQ No.
'i
(If any particular item is not applicable to this project, please enfrrt "Notli gale " qr
I. Processing
APR 14 2003
1. Check all of the approval(s) requested for this project; ?yF _ _
ell ? ?1 ????
?x Section 404 Permit ? ' Riparian r??,Cershe°uffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: GC3362 GC3365 GC3351
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here:
II. Applicant Information
1. Owner/Applicant Information
Name: Darrell Henry
Mailing Address•32640 Chestnut Ridge RD_ North Ridgeville Ohio 44039
Telephone Number: 440 3276543 Fax Number: same
E-mail Address:
2. Agent/Consultant I nformation (A signed and dated copy o f the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires i nformation to b e s ubmitted on sheets n o t arger than 11 b y 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Private Residence " Henry Family
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): J05-6-8
4. Location
8.
County: Pamlico Nearest Town: Merr;fi
Subdivision name (include phase/lot number): Mason Bay lot' 8
Directions to site (include road numbers, landmarks, etc.): N C s R 4 4.29 miles nff N C55
lot next to first major bridge headed toward '-,Flnranro (NCRS1324aka
Florence Whortonville rd)
5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): 3.93
7. Nearest body of water (stream/river/sound/ocean/lake): Mason creek on Bay River
River Basin: Neuse
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http•//h2o.enr.state.nc.us/admin/mai)s/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Wooded lot next water with several fingers of
not completely draining areas protruding towards the middle of the
property across drive area.
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: To clear
trees as needed.improve driveway, excavate for house, grade small areas,
limited fill where needed, construction of private home with boat dockaae---
(eamt) backhoe bob at on rPtP trunks and pump nc.cahlA lnq tr„rk_
11. Explain the purpose of the proposed work: private home with improved driveway
and boat dockage
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
Septic installed 1997 record 1552 permit 3030
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
1980000291 GI1-151 limcrl timo during home constuction
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
1. Provide a written description of the proposed impacts: Poss_i.ble- silt during consrtuction
and water disturbance during dockage piling installat-;on
2. Individually list wetland impacts below:
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
construction 140
- mech clearing 0 "
excavation 0 "
grading 0 130 - 160
fill .10 140 low areas

* List each impact separately and identify temporary impacts. Impacts include, but are not umrtea to: mechanized clearing, grading, nu,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
•• 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at htty://www.fema.gov.
•*• List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: 1.33 acres
Total area of wetland impact proposed: -10
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
- Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
lease specify)

" List each impact separately and identify temporary impacts. impacts include, out are not nnudw to. Cwvciw WO -,,........?...r,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net losstgain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.toi)ozone.com,
www.mapoucst.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 1,;n
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact

Site Number
indicate on ma

Type of Impact* Area of

Impact
acres
Name of Waterbody
(if applicable) Type of Waterbody

(lake, pond, estuary, sound,
bay, ocean, etc.
construction Mason Creek Bay., River

• List each impact separately and identify temporary impacts. impacts inciuae, out are not urmtea to: 1111, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
silt fence straw and landscaping
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restotation
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http•//h2o.enr.state.nc.us/wrp/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. T he applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No [ij If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
* Zone I extends out 30 feet perpendicular from near bank of channel; Gone L extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Gray and rainwater holding tanks to reuse for landscaping needs
XII. Sewage Disposal (required by DWQ)
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.
septic installed 1997
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
- Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

4 ? O C'S/? 0
Applic I- Agent' gnature Date
(Agent's signature is v id only if an authorization letter from the applicant is provided.)
Page 12 of 12
S 56'02' 22' E 20.01' " • A' /
S 38' S9' S2' E 29.07' \ ( 9
S 29' 52' 46' E 51. 64' H'
S 73' 01' 22' W 25.95'
7 \ a
1 ?o
S 73'08'09'E 87.06' o!
S 44.15' S3' E 72.55' \A S 15' 17' 39' E ` N
M. H. W. 26. 6 1'?
MASON CREEK
S 42' 2 i' 50'E 59. 55' MARSH LINE ro
/ w
?o
S 53.27' 10'E 17.67, ?
?`2? ?75' A.E.C. I A
S 1 6' 20' 39' E 73. 12'
S 21'27'26'E 72.68' \ WETLANDS LINE
S 5 1' 23' 47• E 23.59'
S 51.23' 47' E 9. 48'?_? ( \ WL \ I
-g 18. 04' UL
ll/WL ®\.WL ;
s./ UL \ 1
?,3 3.93 ACRES ? \ \
\\ 2 3? 330 U L
UL
UL
v
1 S 3/. N.II.F
O 30% _ a
N. C. GRID AS PER
SK. 178, PG. 197
100 G 100 200 300
S 56' 02' 22' E 20.01' • A O
S 38'59'52'E 29.07-
S 9
29' 52' 46' E 51.64' . H
S 73.01' 22' W 25.95'
\ m
.o
S 73.08' 09' E 87.06'
ID" S o;
15' 17' 39" E \ w
S 44' 15' 53' E 72.55' 26. 6 1'
M. H. W.
MASON CREEK 1-, /
S 42' 2 I' S0' E 59. 55' MARSH LINE rv
w
e
1 S 53'27' 10'E 17.67 /
75' A.E.C. I a
S 16'20'39'E 73. 12'
S 21'27'26"E 72.68' WETLANDS LINE
S 51'23'47"E 23.59'
(? V
S 5 I' 23' 4T' E 9. 48'` A- 16. 04' Vn \

v
/i WL \ J \ UL \
,.
UL 3. aC
UL
N. C. GRID AS PER
l1•-? = BK. 176, PG. 197
1 -'
40 X24 "?,, ..

1•
N. I.F
Mason Bay
LOT #8
100 G 100 200 300
NOTE: ??Fr?
This drawing was created for preliminary planning and Is not a - ----- I
complete description of the lot shown. It Is not for subdivision
description. It Is notforreoordadon, conveyance or final design. See
subdivision plat and restrictive covenants for further description.
Pamlico County, NC
Legend
.? Marsh
O `?o ^
PAMLICO COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION:
CERTIFICATE OF COMPLETION
"( ) OPERATION PERMIT
ISSUED T0: ,ON PERMIT#
ADDRESS: RECORD # 1552
MAP #. JOS-6-8
PHONE: SF. # OFF 1324
LOCATION: S/D ON 1324 BEFORE FLORENCE INTERSECTION
MASON-BAY-ESTATES- LOT # 8
WATER SUPPLY:
PUBLIC
( ) PRIVATE: feet from closest point of septic system
"INSTALLER: : to ` J::: 12A to CODE #
APPROVAL: This `system has been inspected by*the signing Sanitarian and
has been APPROVED as shown on the:
{ ) PLOT PLAN
FINAL PLOT
( ) ELECTRICAL INSPECTIONS APPROVAL RECEIVED: SEE ATTACHMENT
OPERATIONAL PERMIT/'RESTRICTIONS AND'?STIPULATIONS:
( ) This system will be inspected time(s) a year
( )'WATER.CONSERVATION DEVICES OR METHODS
Comments'-
( ) ADDITIONAL:

t*ar*+t:xt*:*x*t?*+?**««?xttx«xt.FINAL ornq-

SANITARIAN't VAL DATE
NOTE: THE OWNER OR CONTROLLER RTY S RESPONSIBLE FOR THE
MAINTENANCE OF A GROUND ABSORPTION SEPTIC SYSTEM IN A MANNER
WHICH WILL NOT EMIT EFFLUE14T OR CONTAMINATION TO GROUND SURFACE
OR SURFACE WATERS. VIOLATIONS OF THIS LAW ARE PUNISHABLE AS A
MISDEMEANOR UNDER G.S.130A-23&25. (Ref.1961)
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FINAL PLAT OFI
MASON BAY
I.a? ...,•,?,., urrl WEYERHAEUSER . PAILICO NUMBER 36
e96 'ST[11[Y [SPATE •IIA[Yf SOaa 1 I if ''' O""' wa. w. » :yti YN rw •r'? ?Ir NUMBER E T"P., PAMLICO COUNTY. N.C.
s.s.a?..••w •www...rw SCALE: 1• • 100' . DATES SEPT. 27. IGGB
r rw ..... www• «rw.w
w•awwl DINNER:
ALAN SELL SURVEYING SURVEYED B WEYERNAEUSER AM ESTATE COMPANY
.» • I« Iw •."?..w N••' I.O. BOX 1311
8WA CEDAR.NNSB0110 PO. I C. NT BLVD. MvNO 1•..Ln ' MEW BUN. N.C.
»r•N asrl 1 IaN' GWA
IWIw N Iw11M• JOG YO. IS•
/
t1ja cat+°1 ? •-,`k
t216 r
COUNTY NEIGHBORHOODS
t,„r.t••.
See other side for numbers 1.21
(Oriental Neighborhoods) and ;;
+\ 59 (Minnesott Beach). ?°•? ?•• t,ta•=
\ ?i •,?,b..t_ ??" `z+° 2 reek
?:• 2 Hid
W,
Point
PAMLI ?'•. tan ay &
`' Q TMdian Estates
5 i
..
COUNTY nnesott Estates
"? Creak
a s : s
06 ear :':r t«°t,. ui 04 ?? 27 Neus s
- 6- 29 Pelican
C i?j5s w * , a ?i
ip• OC',oc ?._...,_ ..a•,.?.__-•.__ I_ Point
,•d astrty
QRrOa
.rRntt {, s '" \ 31 d View
?"" •t. i Broad Creek Village
tea ,r,j ? ler.:ht t t {! U+? o° 'tom 3? t
"0`4 ,a ?, p ht4 ?•rµ NY pY+F ° ;\ 33 Up the Creek j` C trt . r° Baybor° I? ttp • , Forest
ss ti `o ?° ,? Ill - ,:„ ? ? • •,?, shore Estates
?,• s`s .,°+ , ? ? „?' a f * w, 52 49 34 Cartwright
0346 =
36 Fork Point
134" 0 ., Waters
„le' - ---•-? - - -._ _ _.. ? x \. 3 ?? qA ° Edge
,J W4 4s 37 Browns Creek
?. - - 38
a) --- - picers Creek
/p etc• ugnt 4ro•?•C rae,+n i `? {? ` ?;, 39 Headwaters
?? ,?9q I s9 gam, + 40 Sunset Shores
?- rtaa '? ? `?,a , nin,u M • ?a1 ,,1?
41 Silver Acres
\ ? .?" tu} - 42 Paradise Shores
,'' ,,21 ?,,> tu6?+ 43 Mason Say
.? 4 N PAK ICO ti•??t+ 3 n?9 r? ..lw.? 44 ?`,° sob 0COMMUKITT t 45 Moo Shore Estates
COLLEGE 30%g ,e 46 Dogwood Landing
"? t oo anding
SS?? 47 Bayview Estates
48 Sall Creek
.I
1oos''f 49 Brandy Bay
5 ,Dp51 '• 50 Osprey Point
Aro9°?p0 ?0y, 51
Creek Point
52 Bell Point
t106 53 Bay Breeze
ii '••'?? ,X`L ? ? ? ?iJMfo,,
z 54 Baird's Shores
Jr "'' t?+r. ?? 55 Saltayre
Y. 56 Cabin Creek
• ''"'t ;'r 57 Dawson Bluff
l"' ,l a 58 Oriental plantation
a.
DWQ# QSQa,5_Triage On-Hold Letter 2.0 Staff Contact Date 1151
$$) Plan Detail Incomplete
? Please provide a location map for the project.
t
? Please show all stream impacts including all fill sloes, dissipators, and b k stabilization on the site plan.
?
?le-ase- proviJe- a de,kaCileJ 5i*o- '
P4aa6a*4ew4ll wetllind impacts including fill slopes on the site plan.
? Please indicate all buffer impacts on the site plan.
I?Qt)e P ro???e de'+a?ls
C Please indicate proposed lot layout as overlays on the site plan.
?ov- +he dock ?e=t) r)
? Please indicate the location of the protected buffers as overlays on the site plan. ssi
(3 Please locate all isolated or non-isolated wetlands, streams and other waters of the State as overlas on the l plap rt. i VA a C 1 S A 0
? Please provide cross section details showing the provisions for aquatic life passage. 1
W ave_r5 CM o.so
a Please locate any planned sewer lines on the site plan. C
? Please provide the location of any proposed stormwater management practices as required by GC
? Please provide detail for the stonmwater management practices as required by GC
? Please specify the percent of project Imperviousness area based on the estimated built-out conditions.
? Please Indicate all stormwater outfails on the site plan.
? Please indicate the diffuse flow provision measures on the site plan. .
? Please indicate whether or not the proposed impacts already been conducted.
$$) Avoidance and/or Minimization Not Provided
O The. on the plans does not appear to be necessary. Please eliminate the or provide additional information as to why
It is necessary -for this project
I l?adin9 ?o ?1o(At e_ ?a -0 1N?F?ca ?n?S '
) }
This Office believes that the FQJ can be moved or reconfigured to avoid the Impacts to the Please on
revise the plans to avoid the impacts,
This Office believes that the - iaesiarton the plans ar . can be moved or reconfigured to minimize the impacts to the Please
revise the plans to minimize the impacts.
? The stormwater discharges at the location on the plans labeled will not provide diffuse flow, through the buffer because . Please
revise the plans and provide calculations to show that diffuse flow will be achieved through the entire buffer. If it is not possible to achieve diffuse
flow through the entire buffer then. it may be necessary to provide stormwater management practices that remove nutrients before the stomnvater
can be discharged through the buffer.
$$) Other
? The application fee was insufficient because over 150 feet of stream and/or over 1 acre of wetland impact was requested. Please provide $
This additional fee must be received before your application can be reviewed.
? Please complete Section(s) on the application.
.0 Please provide a signed copy of the application.
? Please provide copies of the application, copies of the site plans and other supporting information.
$$) Mitigation
? of compensatory mitigation is required for this project. Please provide a compensatory mitigation plan. The plan must conform .
to the requirements in 15 A NCAC 2H.0500 and must be appropriate to the type of impacts proposed.
? Please indicate which 404 Permit the USACE would use to authorize this project.
¦ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
0 Print your name and address on the reverse
so that we can return the card to you.
¦ Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
PC-V'1 It Co
Darrell Henry 32640 Chestnut Ridge Road
Nor Ridgeville, Ohio 44039
()3 - C) I5 5 [+G 14
A.
by (
mob'
D. Is delivery address different fro
If YES, enter delivery address
? Agent
? Addressee
Date of Delivery
'X- &
1? ? Yes
? No
3. Servjce Type
Certified Mail ???E?tpress Mail
? Registered Id"ReZrn Receipt for Merchandise
? Insured Mail ? C.O.D.
4. Restricted Delivery? (Extra Fee) ? Yes
2. Article Number 7002 3150 0004 9 315 3117
(rransfer from service fabeo
PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-1540
UNITED STATES POSTAL SERVICE First-Class Mail
Postage & Fees Paid
LISPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
NC DENR Division of Water Quality
Wetlands/401 Certification Unit
2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604