20221642 Ver 1_ePCN Application_20221117

DWR
Division of Water Resources
Initial Review
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 13, 2022 Ver 4.3
Has this project met the requirements for acceptance in to the review process?*
Yes
No
Is this project a public transportation project?*
Yes No
Change only if needed.
Pre -Filing Meeting Date Request was submitted on:
11/17/2022
BIMS # Assigned * Version#*
20221642 1
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Select Project Reviewer*
Robert Tankard:eads\rbtankard
Information for Initial Review
la. Name of project:
COURTESY COPY 8528 S Old Oregon Inlet Road
la. Who is the Primary Contact?*
Troy Murphy
Reviewing Office*
Washington Regional Office - [phone]
1 b. Primary Contact Email:* lc. Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
11/17/2022
Nearest Body of Water
Roanoke Sound
Basin
Pasquotank
Water Classification
SA-HQW
Site Coordinates
Latitude: Longitude:
35.892483 -75.589192
A. Processing Information
County (or Counties) where the project is located:
Dare
Is this a NCDMS Project
Yes No
Is this project a public transportation project? *
Yes No

la. Type(s) of approval sought from the Corps:
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
Yes
No
1 b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
lc. Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit (NWP) Number: 18 - Minor Discharges
NWP Numbers (for multiple NWPS):
ld. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
1f. Is this an after -the -fact permit application?*
Yes No
lg. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
lg. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1 h. Is the project located in any of NC's twenty coastal counties?
Yes No
1 i. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
Yes No
1j. Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
Id. Who is applying for the permit?
Owner Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
Cam Realty, LLC
2b. Deed book and page no.:
DB 1891, PG 360
2c. Contact Person:
Susan MacDonald
401 Water Quality Certification - Express
Riparian Buffer Authorization
Unknown
Yes No
Yes No

2d. Address
Street Address
105 Carter Road
Address Line 2
City
Plymouth
Postal / Zip Code
06782
2e. Telephone Number:
[phone]
2g. Email Address: *
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Mike McVearry
3b. Business Name:
3c. Address
Street Address
2508 S. Virginia Dare Trail
Address Line 2
City
Nags Head
Postal / Zip Code
27959
3d. Telephone Number:
[phone]
3f. Email Address: *
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Troy Murphy
4b. Business Name:
Quible & Associates P.C.
4c. Address
Street Address
PO Box 870
Address Line 2
City
Kitty Hawk
Postal / Zip Code
27949
4d. Telephone Number:
[phone]
4f. Email Address: *
[e-mail]
C. Project Information and Prior Project History
State / Province / Region
CT
Country
USA
2f. Fax Number:
State / Province / Region
NC
Country
USA
3e. Fax Number:
State / Province / Region
NC
Country
USA
4e. Fax Number:
1. Project Information
1 b. Subdivision name:
(if appropriate)
lc. Nearest municipality / town:
Nags Head
2. Project Identification

2a. Property Identification Number:
070912979085
2b. Property size:
0.32
2c. Project Address
Street Address
8528 S Old Oregon Inlet Road
Address Line 2
City
Nags Head
Postal / Zip Code
27959
3. Surface Waters
3a. Name of the nearest body of water to proposed project: *
Roanoke Sound
3b. Water Resources Classification of nearest receiving water: *
SA-HQW
3c. What river basin(s) is your project located in?*
Pasquotank
3d. Please provide the 12-digit HUC in which the project is located.
030102051502
4. Project Description and History
State / Province / Region
NC
Country
USA
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application: *
The site is currently undeveloped uplands and wetlands. Adjacent parcels include single family residences and undeveloped uplands and wetlands.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
Yes No Unknown
If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
NWP 18, Action ID: 200510371
4f. List the total estimated acreage of all existing wetlands on the property:
0.22
4g. List the total estimated linear feet of all existing streams on the property:
No streams present
4h. Explain the purpose of the proposed project: *
Fill of 0.03 acres of wetlands to accommodate a single family residential development. A fill permit was issued in 2005 for 0.10 acres of wetland fill, mitigation was paid, but only 0.05 acres
of wetlands were filled. This permit would be to complete the necessary fill to accommodate the proposed development and fill the remaining previously permitted fill.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The proposed project will consist of filling 0.03 acres of wetlands using dump trucks, skid steer, and silt fencing to contain the proposed fill.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
Action ID: 200411585
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Unknown
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
2004, USACE Approved Determination
6. Future Project Plans

6a. Is this a phased project?*
Yes No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries
Open Waters Pond Construction
2. Wetland Impacts
Buffers
2a. Site #* (?)
2a1 Reason (?)
2b. Impact type*(')
2c. Type of W.*
2d. W. name
2e. Forested*
2f. Type of Jurisdicition*
(?)
2g. Impact
area*
1
Residential
Development
P
Estuarine Woody Wetland
Wetland
No
Corps
0.030
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.030
21. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
2g. Total Permanent Wetland Impact
0.030
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The proposed fill area has been minimized to achieve the desired single family residential development of this lot. The existing uplands are being
utilized.
lb. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Silt fencing will be used to contain all fill proposed. All fill will be sloped in a manner that does not promote erosion.
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 this project DOES NOT require Compensatory Mitigation, explain why:
A fill permit was issued in 2005 for 0.10 acres of wetland fill, mitigation was paid for the full 0.10 acres, but only 0.05 acres of wetlands were filled.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No
If no, explain why:
No riparian buffers present within the Pasquotank River Basin.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250? *
Yes No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
Yes No
Comments:
G. Supplementary Information

1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land? *
Yes No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)?*
Yes No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
Yes No
3b. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
Yes No N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
Yes No
5d. Is another Federal agency involved?*
Yes
5e. Is this a DOT project located within Division's 1-8?
Yes No
No Unknown
5j. 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 an Essential Fish Habitat?*
Yes No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat? *
No surface water impacts are proposed.
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 status?*
Yes No
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 development is allowable within the AE flood zones, as long as the first floor elevation exceeds the base flood elevation.
8c. What source(s) did you use to make the floodplain determination?*
NC FRIS (Flood Risk Information System)
Miscellaneous

Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one file when
possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred.
Click the upload button or drag and drop files here to attach document
NRCS_Soil_Map.pdf
USGS-ROANOKE ISLAND NE.pdf
authorization buyer 8528.pdf
authorization owner 8528.pdf
P22160-NAT 18-LOT 2-111722.pdf
File must be PDF or KMZ
Comments
443.38KB
1003.92KB
34.63KB
34.98KB
298.62KB
The applicant does not have an email address, the email address provided belongs to his Real Estate Agent Greg Green from Village Realty.
Signature
By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief'; and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• I have given true, accurate, and complete information on this form;
I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
I intend to electronically sign and submit the PCN form.
Full Name:
Troy Murphy
Signature
l °i' 44tlf*&
Date
11/17/2022

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11 /11 /2022
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Soil Map —Dare County, North Carolina
MAP INFORMATION
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Page 3 of 3

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ENGINEERING * CONSULTING * PLANNING
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Phone: [phone]
Fax: [phone]
Web: www.quible.com
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Date: 11 /11 /22
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Location: 035° 53' 31.84" N 075° 35' 22.59" W
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Datum: NAD27

RE: Dare County Parcel # 007976000, PIN # 070912979085
8528 S. Oregon Inlet Rd., Nags Head, NC
As contracted purchaser, I authorize Quible & Associates, P.C. (Quible) to act as permitting
agent on my behalf for the purpose of obtaining a Nationwide 18 Permit and 401 Water Quality
Certification if necessary. And, I authorize USACE and NCDWR to access the above
referenced property as necessary for the same purpose.
Authorized Signature
Name: Date:

RE: Dare County Parcel # 007976000, PIN # 070912979085
8528 S. Oregon Inlet Rd., Nags Head, NC
As owner representative of Cam Realty, LLC (owner of the above referenced property) in Nags
Head, NC, I authorize Quible & Associates, P.C. to act as permitting agent for the purpose of
obtaining a Nationwide 18 Permit and 401 Water Quality Certification if necessary. And, I
authorize USACE and NCDWR to access the above referenced property as necessary for the
same purpose.
Authorized Signature
Name:
Date:
Title:

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