20001357 Ver 1_COMPLETE FILE_20001025

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
1 • ?
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
October 30, 2000
Dare County
DWQ Project # 001357
APPROVAL of 401 Water Quality Certification
John R. Rice
622 Grennwich Street
Worthington, Ohio 43085
Dear Mr. Rice:
You have our approval, in accordance with the attached conditions and those listed below, to fill 0.01 acres of
wetlands in Dare County for the purpose of residential construction as you described in your application received by
the Division of Water Quality on October 25, 2000. After reviewing your application, we have decided that this fill
is covered by General Water Quality Certification Number 3106. This certification allows you to use Nationwide
Permit Number 18 when the Corps of Engineers issues it. In addition, you should get any other federal, state or local
permits before you go ahead with your project including (but not limited to) Sediment and Erosion Control, Coastal
Stormwater, Non-Discharge and Water Supply Water shed regulations. This approval will expire when the
accompanying 404 or CAMA 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 wetland fills for this project (now or in the future) exceed one acre, compensatory
mitigation may be required as described in 15A NCAC 2H.0506 (h) (6) and (7). For this approval to be valid, you
must follow the conditions listed in the attached certification.
If you do not accept any of the conditions of this certification, 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.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If
you have any questions, please telephone John Dorney at 919-733-9646.
Si eretteh'sl
Attachment
cc: Corps of Engineers Washington Field Office
Washington DWQ Regional Office
Charles Thomas Corpening, PO Box 831, Avon, NC 27915
File Copy
Central Files
001357
Division of Water Quality • Non-Discharge Branch
1621 Mail Service Center, Raleigh, NC 27699-1621 Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer • 50% recycled/10% post consumer paper
http://h2o.enr.state.nc.ustwetiandc.html
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g
N
AGENT AUTHORIZATION FORM o,
FOR
CORPS OF ENGINEERS PERMIT APPLICATION
I John K Rice , the undersigned authorize Charles T. Corpening to act
as my agent to obtain a U. S. Army Corps Fill permit for the work as described in the
attached application & plans.
001357
Date: A11-17-2000

DEMID0 013 5 7
CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TH THE APPROPRIATE
FIELD OFFOCE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET.) SEVEN
(7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET) PLEASE PRINT.
1. OWNERS NAME: Jolm R Rice
2. MAILING .ADDRESS: 622 Grennv icit St.
SUBDIVISION NAME:
CITY: Worthin on STATE: Ohio ZIP CODE: 43085
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): Lot 15 Hatteras Pines Pin # 02 0536 09 16 6649
3. TELEPHONE NUMBER (HOME): 252-995-4825 ( WORK)
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICAL, ADDRESS,
PHONE NUMBER: Charles Thomas Co _ggging P.O. Box 831 Avon N.C. 27915
Phone number [phone]
5. LOCATION OF WORK(PROVIDE A MAP, PREFERABLYA COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Dare NEAREST TOWN OR CITY: Buxton
1.
SPECIFIC LOCATION (INCLUDE ROAD
NUMBERS, LANDMARKS, ETC.) See location sketch on fill plan
6. IMPACTED OR NEAREST STREAM/ RIVER: Panilico sound
RIVER BASIN:
7a IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER (SA),
HIGH QUALITY WATERS (HOW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-1 OR WS-II)? YES ( ) NO ( X ) IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ( ) NO (X)
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
Conservatim
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES ( ) NO (X) IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION) :
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ( ) NO (x ) IF YES, DECRIBE ANTICIPATED WORK:
9a ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND:
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
2.
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: 0.01 EXCAVATION: N/A
FLOODING: N/A OTHER: N/A
DRAINAGE: N/A TOTAL ACRES TO BE IMPACTED: 0.01
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION) :
LENGTH BEFORE: FT AFTER:
WIDTH BEFORE (based on normal high water contours):
WIDTH AFTER:
AVERAGE DEPTH BEFORE: - FT AFTER: FT
. (2) STREAM CHANNEL IMPACT WILL RESULT FROM: (CHECK ALL THAT APPY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND?
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED (ATTACH PLANS: 8'/z" X 11" DRAWINGS ONLY):
Fill wetland area with suitable material Fill to be brought in by dump truck and spread by backhoe &
bulldozer.
13. PURPOSE OF PROPOSED WORK: To provide suitable access to building site
3.
14. STATE REASON WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IIVIPACTS):
Tlus is the only way to access the lot
15. YOU ARE REQUIRED TO CONTACT THE U. S. FISH AND WILDLIFE SERVICE (USFWS)
AND/OR NATIONAL MARINE FISHERIES SERVISE (NMFS) (SEE AGENCY ADDRESS SHEET)
REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR LISTING
ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA
THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED.
TTACH RESPONSES FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESS SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED:
17. DOES THE PROJECT INVOLE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES ( ) NO (X) (IF NO, GO TO 18)
a IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN
ENVIRONMENTAL DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE
NORTH CAROLINA ENVIRONMENTAL POLICY ACT?
YES ( ) NO ( )
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH
CAROLINA DEPARTMENT OF ADMINISTRARION STATE CLEARINGHOUSE?
YES ( ) NO ( )
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRITE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
4.

18. ACTIVITiTY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO
WETLANDS:
a WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21,
26,29,AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE
PROPERTY MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH
EQUALS50 FEET OR 1 INCH EQUALS 100 FEET THE FOLLOWING ITEMS SHOULD BE
INCLUDED WITH APPLICATION IF PROPOSED OF THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED
BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY? Residential
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
Private Waste Water Systent
f SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U. S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAICER OF A 401 DIVISION OF ENVIRONMENTAL
MANAGEMENT (WATER QUALITY ) CERTIFICATION, AND
3) (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DMSION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL
MANAGEMENT PROGRAM
O S SI DATE
(AGENT'S SIGIVA ID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18&)
5.
SCHOOL
C R AD 605040302010 0
60 120 180
BUXTON NC Note: Survey based upon physical evidence found as shown. Meridian
CROOKED RIDGETRAI $ for survey based upon recorded bearing S 76°2744" W for line A -B per
C PC "C SLIDE 90B.
RI
DEER 9 1 C:_ \
RUN
SITE -?' ILL RIDGE RI
LC-57.19' LOT 50
LOCATION SKETCH, NOT TO SCALE LC8-N 70"2934' E
LEGEND b11's6'z0'R-274.94' \
L-s7.z9'
O EXISTING CONCRETE MONUMENT ?
O EXISTING IRON STAKE LOT 49
0 UTILITY POLE
FIRE HYDRANT - - / L
® WATER METER
m PED10CK
t 11? V ' 4 '
1 HIGHLAND
VWF1lAND1 ? rW A 71.79sgry
S%.51,q R IP 34.04' 'Ir N 87.50'06' W..,??
©" - - S 70'2T 4M1/ Rl R7 w 41 IF I IN
S 76^'ZT 4 W - * "1111. AREA 1;y
1 471:91 sq if
'27112 ?": 1 RR R" Iv97(1171 ?Iry \ v, TIRE t1YDRANT
t??? 16 RI L(X'AIFOINSOUTH
-, IIIQI II AND RA
B ' "L 1n7. i" ,., ry R/w or DEER RUN
,(?7???+' LOT 1 7 CIRCLE AND NEAR 1TIE
1 - 1 NORTIILOECORNER
LOT 18 ' (In(lr In& if.
1
T From To Bearing Distance
IP Al N 8°24'10" W 13.36'
Al A2 N 76°59'30" E Z
17.68' LOT 14
A2 AB S 83°56'59" E
AB 34.78' ? w
A3 S 83°56'59" E 2.55' a`
A3 A4 N 74052'27" E 26.46' CD
From To Bearing Distance m
BA BI N 53°24146" W LOT 15
61 B2 6.29' 0.74 acres
N 53024-46' W 49.92' 31,244.29 sq ft V
B2 B3 S 88°29'53" W 14.98( Ld °?
B3 B4 S 50°57'22" W 37.37' w O7-
B4 BB S 50°57'22" W 3.75' °
NOT
DELINEATED
-?_- N 81°55'34" E 89.85'
------- O'--
U.S.NATIONAL PARK SERVICE
y D. Rankin
PLS
,
L50232
uccaneer Dr., PO Box 121 FILL PLAN FOR
JOHN R
R I C E
o, NC 27936-0121 .
4405 Fax [phone] PATR I C I A M. RICE
I, Freddy D. Rankin, Professional Land Surveyor,
certify that this plat was drawn f LOT 15
rom an actual
field land survey and that the error of closure as u p q
' l A?E(?/ 15 PINES
calculated by latitudes and departures is at least
1:10
000 BUXTON, NC
,
•
Witness my hand and seal this day of Township
HATTERAS County
DARE State
A.D. Date File Number F.I.R.M. Zone NORTH CAROLINA
09 14 00 1821-ZD
Scale FB/Pg X & OPA
B Pin Number
02 0536 09 16 6649

Freddy D. Rankin, P.L.S., L--2958 1" = 60' 063 ase Flood Elevation
N/A Zoning
SED-1
Recorded Reference
PC "C" SLIDE 90B Community/Panel/Suffix
375348 0820 D Average Groun E evation

AGENT AUTHORIZATION FORM
Ca
_C6 PS OF
,. ..,
u
FOR
ENGINEERS PERMIT APPLICATION
001357
I John R Rice , the undersigned authorize Charles T. Corpening to act
as my agent to obtain a U. S. Army Corps Fill permit for the work as described in the
attached application & plans.
Sincerely,
Date: /,1/-t7-2000
DIEM ID: 0 0 1 3 5 7
CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #)
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TH THE APPROPRIATE
FIELD OFFOCE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET.) SEVEN
(7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET) PLEASE PRINT.
1. OWNERS NAME: John R Rice
2. MAILING ADDRESS: 622 Grennwich St.
SUBDIVISION NAME:
CITY:_ Worthington STATE: Ohio ZIP CODE: 43085
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): Lot 15 Hatteras Pines Pin # 02 0536 09 16 6649
3. TELEPHONE NUMBER (NOME): 252-995-4825 (WORK)
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICAL, ADDRESS,
PHONE NUMBER: Charles Thomas QMninst P.O Box 831 Avon N.C. 27915
Phone number 2)995-3175
5. LOCATION OF WORK(PROVIDE A MAP, PREFERABLYA COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Dare NEAREST TOWN OR CITY: Buxton
1.
SPECIFIC LOCATION (INCLUDE ROAD
NUMBERS, LANDMARKS, ETC.) See location sketch on fill elan
6. IMPACTED OR NEAREST STREAM/ RIVER: Pamlico sound
RIVER
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER (SA),
HIGH QUALITY WATERS (HOW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-ti)? YES( ) NO (X ) IF YES, EXPLAIN:
7b. 1S THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ( ) NO (X)
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEEPAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATIOW
Conservation
8a HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES ( ) NO (X) IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION) :
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ( ) NO (x) IF YES, DECRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND:
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
2.
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: 0.01 EXCAVATION: N/A
FLOODING: N/A OTHER: N/A
DRAINAGE: N/A TOTAL ACRES TO BE IMPACTED:-Q. 01
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION) :
LENGTH BEFORE: FT AFTER:
WIDTH BEFORE (based on normal high water contours):
WIDTH AFTER FT
AVERAGE DEPTH BEFORE: FT AFTER: FT
(2) STREAM CHANNEL IMPACT WILL RESULT FROM: (CHECK ALL THAT APPY)
OPEN CHANNEL RELOCATION
PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING:-
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND?
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS ONLY):
Fill wetland area with suitable_ material. Fill to be brought in by dump truck and spread by backhoe &
bulldozer.
13. PURPOSE OF PROPOSED WORK: To provide suitable access to building site
3.
14. STATE REASON WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS):
This is the only way to access the lot.
15. YOU ARE REQUIRED TO CONTACT THE U. S. FISH AND WILDLIFE SERVICE (USFWS)
AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESS SHEET)
REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR LISTING
ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA
THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED:
(ATTACH RESPONSES FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESS SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED:
17. DOES THE PROJECT INVOLE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES ( ) NO (X) (IF NO, GO TO 18 )
a IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN
ENVIRONMENTAL DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE
NORTH CAROLINA ENVIRONMENTAL POLICY ACT?
YES ( ) NO ( )
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH
CAROLINA DEPARTMENT OF ADMINIMARION STATE CLEARINGHOUSE?
YES ( ) NO ( )
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRTTE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
4
18. ACTIVITITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO
WETLANDS:
a.
b.
C.
d.
e.
WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21,
26,29,AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE
PROPERTY MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH
EQUALS50 FEET OR I INCH EQUALS 100 FEET THE FOLLOWING ITEMS SHOULD BE
INCLUDED WITH APPLICATION IF PROPOSED OF THEIR EQUIVALENT.
IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED
BY PROJECT.
IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
WHAT IS LAND USE OF SURROUNDING PROPERTY? Residential
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
Private Waste Water System.
f. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U. S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAICER OF A 401 DIVISION OF ENVIRONMENTAL
MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL
MANAGEMANT PROGRAM.
OWNER'S / AGENT'S ATURE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18&)
5.
/U-Z3 Z©oo
DATE

[]
?-?- (
- R AU
BUXTON, NC
5?

I RI
-'

IR
SITE- FU RIDGER
LOCATION SKETCH
, NOT TO SCA
LE
)
LEGEND 1
D EXISTING CONCRETE MONUMENT
O EXISTING IRON STAKE
® UTILITY POLE
)rf FIRE HYD
60 50 40 30 20 10 0 60 120 Note: Survey based upon physical evidence found as shown. Meridian 180
for survey based upon recorded hearing S 76°27'44" W for line A-B per
PC "C", SLIDE 90B.
Az'jfV5&Cj j?')
LC-57.19' \
LCB-N 70'29'34' E
611.56'-274.94' \
L-57.29'
LOT 49
RANT _ ., - ?
® WATER METER
® PED-LOCK
ILIOSI 11
J-? .-TIAND2 r
"' a.oa'
y -?`- 596.57 xI" III,
© LZp44'V
B ..t' 3
271.12 _•--
.-
LOT 18 1
L 1
1 7A3A4
From To
BA Bt
B1 B2
B2 63
B3 B4
B4 BB

H
Bearing Distance
01 01
I
1.0'f 16
LOT 17 I
1
I
Bear_._.. '_ Distance
N 8°24'10" W 13.36'
N 76°59'30" E 27.68'
S 83°56'59" E 34.78'
S 83°56'59" E 2.55'
N 74°52'27" E 26.46'
N 53°24'46" W 6.29'
N 53°24'46" W 49.92'
S 88°29'53" W 14.98'
S 50°5722" W 37.37
S 50°5722" W 3.75'
V
LOT 50
r
I '
J? 1
1
J I
et •? 4 HIC1nANo
71.19 sq h
A y,
N er`;K,
42j.9 1 sgflYVfIlAN171
1110 11 AND LOCA1rD IN SOU111
57+ "?R7 414.62' TIEI N
w y,
y X1111AREA
RR B4 rIRE HYDRANT
1,970 17 a, 11 K
. "?
7°7.T" RA R/W Or DEER RUN
u1, ,,, n
CIRCLE AND NEAR TI IF
NORTII LOT CORNER
or LOT 10?G It.
z
LOT 14
C%
? tv
rn
0
z .
m
LOT 15
0.74 acres
32,244.29 sq ft
w it
W oq
0
NOT
DELINEATED

N 81"' 5--- 89.85'
U.S. NATIONAL PARK SERVICE
Freddy D. Rankin, PLS
50232 S. Buccaneer Dr., PO Box 121
Frisco, NC 27936-0121
(252) 995-441)5 Fax [phone]
I, Freddy D. Rankin, Professional Land Surveyor,
certify that this plat was drawn from an actual
field land survey and that the error of closure as
calculated by latitudes and departures is at least
1:10,000.
Witness my hand and seal this - day of
A.D.
JOHN R. RICE
Freddy D. Rankin, P.I.S., L-2958
, NC
DEFR
RUN
FILL PLAN FOR

PATRICIA M. RICE
LOT 15
HATTERAS PINES

Township BUXTON, NC
County
HATTERAS DARE S
Dale File Number F.LR.M. Zone CAR(
7
4 00 1$21-ZD X &OPA Pin Number
FB/Pg Base Flood Elevation 02 0536 09 16
60' 063 N A Zoning
Recorded Reference (-llRfm?.n:h.7D___?,n ,,. SED-1