20110741 Ver 1_401 Application_20110811

Quible
Quible & Associates, P.C.
ENGINEERING • ENVIRONMENTAL SCIENCES • PLANNING • SURVEYING
SINCE 1959
Roberto Scheller
NC Division of Water Quality
943 Washington Square Mall
Washington, NC 27889
August 5, 2011
RE: Lot 3-4, Block E
Wahab Village Annex
Ocracoke, Hyde County, North Carolina
Nationwide 18 and 401 Certification
Mr. Pelletier,
P.O. Drawer 870
Kitty Hawk, NC 27949
Phone: [phone]
Fax: [phone]
Web: qulble.com
PRINCIPALS
Brian D. Rubino, P.G.
Warren D. Eadus, P.G.
ASSOCIATES
David A. Deel, P.E.
Katherine C. Marchello, P.L.S.
Michael W. Strader, Jr., P.E.
2011074 1

Enclosed is a Nationwide 18 and 401 Water Quality Certification submission for 0.1 acres of
Section 404 wetland impacts associated with a single family residential homesite. The section
404 wetlands line was delineated by Joseph Lassiter and was field confirmed by you in June
2011. Compensatory Mitigation is proposed through payment to Great Dismal Swamp
Mitigation Bank, LLC for their Timberlake Service Area.
Upon review of Session Law 394 and subsequent discussions with Al Hodge related to Tar-
Pamlico Buffer zones, the buffer zones are currently measured from surface waters, instead of
coastal wetlands in this case. The entire Wahab Village Annex was platted in 1962 and this lot
is less than 2 acres and is intended for a single family residential homesite. As requested by
Mr. Hodge, I checked the box for Buffer Zone Authorization on the PCN application.
Enclosed is the following:
• Site Plan
• PCN Application
• USGS Vicinity Map
• Check and Copy of the $240 Processing Fee Check to NCDENR
• Copy of the Hyde County on-site wastewater system Improvement Permit
• Agent Authorization statement
Please review and process this permit request. If you have any questions or require additional
information, please contact me at [phone].
Sincerely,
Qui Associates, P.C.
Brian Rubino
CC: Josh Pelletier, USACE
212@190W[gy
AUG 1 0 2011
DENR • WATER DUALITY
WEitA O AND STORMIYATER BRANCH
Quible
Quible & Associates, P.C.
ENGINEERING • ENVIRONMENTAL SCIENCES • PLANNING • SURVEYING
SINCE 1959
Josh Pelletier
US Army Corps of Engineers
P.O. Box 1000
Washington, NC 27889
August 5, 2011
RE: Lot 3-4, Block E
Wahab Village Annex
Ocracoke, Hyde County, North Carolina
Nationwide 18 and 401 Certification
Mr. Pelletier,
P.O. Drawer 870
Kitty Hawk, INC 27949
Phone: [phone]
Fax: [phone]
Web: quible.com
PRINCIPALS
Brian D. Rubino, P.G.
Warren D. Eadus, P.G.
ASSOCIATES
David A. Deel, P.E.
Katherine C. Marchello, P.L.S.
Michael W. Strader, Jr., P.E.
Enclosed is a Nationwide 18 and 401 Water Quality Certification submission for 0.1 acres of
Section 404 wetland impacts associated with a single family residential homesite. The section
404 wetlands line was delineated by Joseph Lassiter and was field confirmed by you in June
2011. Compensatory Mitigation is proposed through payment to Great Dismal Swamp
Mitigation Bank, LLC for their Timberlake Service Area. Mr. Emil Viola with GDSRB was
contacted and indicated that credits are available if approved by USACE. Please include this as
a permit condition or indicate otherwise.
Enclosed is the following:
• Site Plan
• PCN Application
• USGS Vicinity Map
• Copy of the $240 Processing Fee Check to NCDENR
• Copy of the Hyde County on-site wastewater system Improvement Permit
• Agent Authorization statement
Please review and process this permit request. If you have any questions or require additional
information, please contact me at [phone].
Sincerely,
Quible & Associates, P.C.
VRubino
CC: Roberto Scheller, DWQ
BACK SAND
OCEAN DOLLAR
VIEW
?y OLD MIDDLE
BEACH

SITE
N
PK IN CL
OLD BEACH
ROAD
122.578 S7'--
MIDDLE ROAD
(40'R/W)
. ASPHALT ROADWAY :. ..... ... :. .:
N62'30'00 E
100.00'
VICINITY MAP
NTS
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-.. 5/8 IRF
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00
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COASTAL WETLAND ]LL L ?
LINE ? _ -
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IL (826 sq.ft.)
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HORSE PEN ROAD
(40'R/W)
UNIMPROVED ROADWAY
NOTES:
1. APPLICANT: DARREN BURRUS
P.O. BOX 642
BUXTON, NC 27920
0 IRON ROD/PIPE
E] CONC. MON.
Q PK NAIL
x404 WETLAND FLAGS
FG FINISH GRADE
R/W RIGHT OF WAY
NTS NOT TO SCALE
0 - PROPOSED WETLAND FILL (4,201 SO. FT./0.1 AC.)
AL - EXISTING WETLAND
5/8 IRF
O FG
2. PROPERTY AREA: 9,962 SQ.FT. (0.23 AC.)
A. EX. UPLANDS: 2,971 SQ.FT.
B. EX. WETLANDS:6,991 SQ.FT.
3. PROPOSED WORK:
USING A NATIONWIDE 118: FILL OF (4,201 SQ.FT./0.1 AC)
OF SECTION 404 FRESHWATER WETLANDS ON LOTS 3-4
(REQUIRES 401 WATER QUALITY CERT.)
NOTE: HYDE COUNTY HEALTH DEPT. HAS ISSUED AN
ON-SITE SEPTIC TREATMENT SYSTEM IMPROVEMENT PERMIT
PROJECT
P11041 COPYRIGHT © 2011
QUIBLE & ASSOCIATES, P.C.
DRAWN
0TH 8DR THIS DOCUMENT IS THE PROPERTY OF
QUIBLE & ASSOCIATES. PC. ALL
RIGHTS ARE RESERVED. ANY RE-
CAD REF PRODUCTION OF THIS OR POSSESSION
. WITHOUT PRIOR PERMISSION OF
QUIBLE & ASSOCIATES. PC WILL
CONSTITUTE VIOLATION OF COPYRIGHT
LAWS. VIOLATION WILL BE SUBJECT
DATE TO LEGAL ACTION
7-7-11
NAnONWME 2
LINE BEARING DIST
Al -PL N81-50'42 7.09
PL-A2 N81'50'42W 25.44'
A2-A3 N66'11'31'W 27.17'
A3-A4 N80'34'54"W 29.62
A4-A5 N39 T52"W 25.40'
A5-IR S6Z30'00'W 40.43'
WAR" 3-4. DOCK E
AR" ViLVAVB ANNEX
OCRACOKE TOWNSHIP HYDE COUNTY
GRAPHIC SCALE IN FEET 1'=30 Quible SINCE 1959
NORTH CAROLINA
0 30' 60'

& Associates, P.C.
ENGINEERING * CONSULTING * PLANNING
ENVIRONMENTAL SCIENCES * SURVEYING
NC License#: C-0208
PO Drawer 870, Kitty Hawk, NC 27949
Phone: [phone]
Fax: [phone]
E-Mail: adminlstratorOqulble.com
201 10 T4 1
O?¢ WA7F9
6
o -r
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.0 November 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
AL
) A'd
1. Processing
1 a. Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 18 or General Permit (GP) number:
1 c. Has the NW P or GP number been verified by the Corps? ? Yes ® No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ® Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
? Yes ® No For the record only for Corps Permit:

? Yes ® No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ® Yes ? No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ® Yes ? No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: Lots 3-4, Block E, Wahab Village Annex
2b. County: Hyde
2c. Nearest municipality / town:
2d. Subdivision name: none
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name on Recorded Deed: Darren Burrus
3b. Deed Book and Page No. DB 225/ PG 420
3c. Responsible Party (for LLC if
applicable): N/A
3d. Street address: P.O. Box 642
3e. City, state, zip: Buxton, NC 27920
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 11
PCN Form - Version 1.0 November 2008 Version
Section A. Applicant Information, continued
4. Applicant Information (if different from owner)
4a. Applicant is: ® Agent ? Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: Brian Rubino
5b. Business name
(if applicable): Quible & Associates, P.C.
5c. Street address: P.O. Drawer 870
5d. City, state, zip: Kitty Hawk, NC 27949
5e. Telephone no.: [phone]
5f. Fax no.: [phone]
5g. Email address: [e-mail]
Page 2 of 11
PCN Form - November 2008 Version
B. Project Information and Prior Project History
1. Property Identification
1 a. Property identification no. (tax PIN or parcel ID): 9500-48-6587
1 b. Site coordinates (in decimal degrees): 36.39994'N - 75.92283'W
1 c. Property size: 0.23 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Pamlico Sound
proposed project:
2b. Water Quality Classification of nearest receiving water: SA
2c. River basin: Tar-Pamlico
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Single Family Residential. Nearby properties include single family residential homesites and undeveloped wetlands and
uplands.
3b. List the total estimated acreage of all existing wetlands on the property:
0.16 ac.
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
0
3d. Explain the purpose of the proposed project:
The purpose of this wetland impact permit request is for minor wetland fill impacts associated with the fill of 0.10 acres of
wooded Section 404 wetlands for a residential homesite. The on-site septic treatment system will be located in the
location as permitted by Hyde county Health Dept. (see emclosed Improvement Permit).
3e. Describe the overall project in detail, including the type of equipment to be used:
Proposed building construction and associated grading will require minor wetland impacts. Equipment will include
bulldozer, backhoe, dump trucks
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property / ® Yes ? No ? Unknown
project (including all prior phases) in the past?
4b. If the Corps made the jurisdictional determination, what type
®Preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: Quible & Associates, P.C.
Name (if known): Joseph Lassiter Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
On-site file confirmation by Josh Pelletier in June 2011
5. Project History
5a. Have permits or certifications been requested or obtained for ? Yes ® No ? Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
i
Page 3 of 11
PCN Form - Version 1.0 November 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
® Wetlands ? Streams - tributaries ? Buffers
? Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of Type of wetland Forested (Corps - 404, 10 Area of impact (acres)
Permanent (P) or impact (if known) DWQ - non-404, other)
Temporary T

W1 ®P ? T
fill shrub-forested
404/
? Yes ® No ® Corps
0
10
non-riparian ® DWQ .
W2 ? P ? T ? Yes ? No ? Corps
? DWQ
W3 ? P ? T ? Yes ? No ? Corps
? DWQ
W4 ? P ? T ? Yes ? No ? Corps
? DWQ
W5 ? P ? T ? Yes ? No ? Corps
? DWQ
W6 ? P ? T ? Yes E] No ? Corps
? DWQ
2g. Total wetland impacts 0.10
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f.
Stream impact Type of Stream name Perennial (PER) or Average stream width (feet) Impact
number - impact intermittent (INT)? length
Permanent (P) or (linear feet)
Temporary (T)
S1 ? P ? T ? PER ? INT
S2 ? P ? T ? PER ? INT
S3 ? P ? T ? PER ? INT
S4 ? P ? T ? PER ? INT
S5 ?P?T ?PER ?INT
S6 ? P ? T ? PER ? INT
3g. Total stream and tributary impacts
3h. Comments:
Page 4 of 11
PCN Form - Version 1.0 November 2008 Version
C. Proposed Impacts Inventory, continued
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individual) list all o en water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of
impact number waterbody Type of impact Waterbody type Area of impact (acres)
- Permanent (if
(P) or applicable)
Temporary T
01 ?P?T
02 ?P?T.
03 ?P?T
04 ?P?T
4f. Total open water impacts
4g. Comments:
Page 5 of 11
PCN Form - November 2008 Version
C. Proposed Impacts Inventory, continued
5. Pond or Lake Construction
If and or lake construction pro osed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or (acres)
number purpose of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then ou MUST fill out Section D of this form.
6a.
? Neuse ® Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact (square Zone 2 impact
Permanent (P) for impact Stream name mitigation feet) (square feet)
or Temporary required?
T
B1 ?P?T ?Yes ®No
B2 ? P ? T ? Yes ? No
B3 ? PEI T ? Yes ? No
6h. Total buffer impacts
6i. Comments: Session Law 394 allows this; setback measured from surface waters in this case; the entire Wahab Village
Annex was platted in 1962 and this lot is less than 2 acres.
Page 6 of 11
PCN Form - November 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Fill will be sloped and stabilized; septic system is located as far as possible from wetlands.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Silt fencing to be maintained until disturbed area is stabilized with grass.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State? ® Yes ? No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ® Corps

2c. If yes, which mitigation option will be used for this
project? ® Mitigation bank

El Payment to in-lieu fee program
? Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank: Great Dismal Swamp Restoration Bank, LLC
3b. Credits Purchased (attach receipt and letter) Type non-riparian Quantity 0.1 acres
3c. Comments: According to GDSRB, credits are available in their Timerlake Bank Service Area. If this is acceptable to
USAGE, please condition in the permit. If not, please inform and we will apply for mitigation through NCEEP.
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: warm, cool, cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h.. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 7 of 11
PCN Form - Version 1.0 November 2008 Version
D. Impact Justification and Mitigation, continued
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone Reason for impact Total impact
(square feet) Multiplier Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
I Total buffer mitigation required:
6c. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6d. Comments:
Page 8 of 11
PCN Form - November 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified ® Yes ? No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? ? Yes ® No
2. Determination if the Project Requires a Stormwater Management Plan
2a. Does the project require a Non-404 Jurisdictional General Permit? ? Yes ® No
2b. Is the project subject to General Certification 3704 or 3705? ? Yes ® No
3. Determination of Stormwater Review Jurisdiction
3a. Is this project subject to any of the following state-implemented stormwater ® Coastal counties
management programs (check all that apply)? ? HQW

If so, attach one copy of the approval letter from the DWQ and one copy of the ? ORW
? Session Law 2006-246
approved stormwater management plan. ? Other:
3b. In which local government's jurisdiction is this project? Hyde County
3c. Is this local government certified to implement a state stormwater program? ? Yes ® No
If so, attach one copy of the approval letter from the local government and one copy
of the approved stormwater management plan (or one copy of the approved
Stormwater management plan stamped as approved).
4. Information Required for DWQ 401 Unit Stormwater Review
4a. What is the overall percent imperviousness according to the most current site plan? < 25 % at max. build out
4b. Does this project contain any areas that meet the criteria for "high density" per

General Certifications 3704 and 3705? ? Yes ® No
4c. If the site is over 24% impervious and/or contains high density areas, then provide a brief narrative description of the
stormwater management plan.
4d. Has a completed BMP Supplement Form with all required items been submitted
for each stormwater BMP? ? Yes ®No
Page 9 of 11
PCN Form - Version 1.0 November 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the ? Yes ® No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ? Yes ? No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ? Yes ? No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
ddi
i ® Yes No
?
a
t
onal development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
An on-site septic treatment system will be installed to serve the proposed house (see Hyde County Improvement Permit).
Page 10 of 11
PCN Form - Version 1.0 November 2008 Version
F. Supplementary Information, continued
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or Y
? es No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ® No
impacts?

5c. If yes, indicate the USFWS Field Office you have contacted. ?
Raleigh
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC Natural Heritage Program
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Mapping data and field investigation; proposed impact area is not within an area of surface waters.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation ? Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
National Register of Historic Places
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? -®-Yes ? No
8b. If yes, explain how project meets FEMA requirements: This type of fill is allowable with permit in AE zones.
8c. What source(s) did you use to make the floodplain determination? NFIP Flood Zone Maps (www.ncfloodmaps. com)
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Applicant/Agent's Printed Name __
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant Date
is rovided.
Page 11 of 11
PCN Form - November 2008 Version
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--- - - - -- - - - - - ---- --- ---- - - --
Copyright (C) 1998, Maptech, Inc.
DARREN T. BURRUS
RENEE M. BURRUS
252-995-4718
P.O. BOX 642, 48197 FROG POND LN.
BUXTON, NC 27920
PAY TO THE (I
ORD R OF n
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66-679/531 4168
DATE
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x:053 X067991: 003334440611' 4 L6B
Esra,E
HYDE COUNTY HEALTH DEPARTMENT
P.O. BOX 100 SWAN QUARTER, NC 27885
1100 MAIN ST.
IMPROVEMENT PERMIT
Permit No: 71911-2 Date: 3uly 19, 2011
Permittee: Darren Surrus
Address: P.O. Box 642, Buxton, NC 27920
Phone No.: [phone]
Property Location: Lot #'s 3 & 41 BlkE, Wahab Village Annex S/D, Ocracoke
Facilities To Be Served: 4 bedroom house
Water Supply: community
Wastewater Flow GPD: 480 gpd
Wastewater System Type: Va, IWWS-98-1-R3, Puraflo Peat Biofilter, Type A
Wastewater System Repair Type: same
Long Term Acceptance Rate: 1.0 gpd/sq.ft.
Absorption Area: 480 sq.ft.
Septic Tank Capacity: 1000 gallons with Zabel A-100 filter
Pump Tank Capacity: 1000 gallons minimum
Total Bed Length: 32' Width: 15'
Maximum Bed Bottom Depth: 6" below the naturally occurring soil surface
IMPROVEMENT PERMIT
DARREN BURRUS
PAGE 2
CONDITIONS:
1. Installation of the wastewater system shall be in strict accordance with the
approved site plan, all specifications of this permit, and the Wastewater
System Approval #IWWS-98-1-R3.
2. Prior to the installation of the wastewater system, an on-site pre-
construction conference shall be held and attended by the installer, Hyde
County Health Department, and the owner or owner's representative.
During this conference the wastewater system shall be staked out on the lot.
3. Clear the vegetation and root mat in the 15'x 32' area shown on the site
plan with as little disturbance to the soil as possible. Restore to the original
elevation using clean sand fill.
4. The manufacturer's field representative shall provide written confirmation of
their acceptance of the system installation prior to Operation Permit
issuance.
5. The installer shall co-ordinate with the Hyde County Health Department in
performing the 24 hour water tightness test on the pump tank and septic
tank.
"The estimated life of the peat media is currently 1 years. The media may
need to replaced,, in part or in full, in order to maintain specified
tr tinent standards.'
7. Use water conserving fixtures i.e. 1.6 gallon flush toilets, 2 gpm shower
heads,1 gpm all lavatories. Try to spread laundry loads out during the week.
Do not pour grease or harsh chemicals into the house drains.
8. Note the PME requirements. Prior to the issuance of the Operation Permit, a
contract with a North Carolina certified subsurface operator who is also
certified by Bord NA Mona Environmental Products U.S., Inc. shall be
executed and a copy submitted to the Hyde County Health Department as
per the PME requirements.
IMPROVEMENT PERMIT
DARREN BURRUS
PAGE 3

This Improvement Permit shall be valid:
WITHOUT EXPIRATION
upon a showing satisfactory to the Department or the local health department that
the site and soil conditions are unaltered, that the facility, design wastewater flow,
and wastewater characteristics are not increased, and that a wastewater system
can be installed that meets the permitting requirements in effect on the date this
permit was issued. This permit is subject to revocation if site plans or the
intended use changes.
Authorized
Envirofimental Health S'peciailst
Hyde County Health Department
V?.

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(40IR 4)
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--PROPERTY i5 LOCATED IN A F.I.R.M.
20NE AE(6') (suakcT TO CAHANGE BY E M A.)
-AREA -9,962sq.ft.(COORO)
-HYDE CO. PIN# 9500-48--5587(LOT 3)
9500- 48-7620(LOT 4)
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I
SURVEY FOR
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' DARREN T. BURRUS
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». rrrH LOTS 3-4, BLOCK E
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GIS TILN WAHAB VILLAGE ANNEX
;.r of , j At aka: ' 225, PG 42v/Ales ? PC 15A
OCRAC;OKE OCRACOKE TWSP. HYDE CG. N, CAROLINA

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P019 7159 KOH, NC 27948 [phone] E-0594

July 27, 2011
RE: Lots 3-4, Block E
Wahab Village Annex
Ocracoke, Hyde County, NC
As current owner of the above reference property, I authorize Quible & Associates, P.C. to act
as agent for the purpose of environmental permitting, including USACE, DWQ and CAMA
permits if necessary.
Authorized Signature
Owner Name: Darren Burrus Date `7 - 2-4T -t l